DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172999

Prevalence of constitutive and inducible clindamycin resistance among clinical isolates of Staphylococcus aureus in a tertiary care institute in North India

Jeevan Shetty, Zarrin Afroz

Abstract


Background: Clindamycin is an important drug used in the treatment of Methicillin Sensitive Staphylococcus aureus (MSSA) as well as in Methicillin-resistant Staphylococcus aureus (MRSA) infections. This drug is widely used in the treatment of skin and soft tissue infections caused by them. Therapeutic failure caused by macrolide-lincosamine-streptogramin B constitutive and inducible clindamycin resistance (MLSBc and MLSBi) is being more commonly reported.

Methods: The present study was conducted over a period of six months from October 2016 to March 2017 to know the incidence of MLSBc and MLSBi in Staphylococcus aureus (S. aureus) isolates obtained in our hospital by D-test as per CLSI guidelines. A total of 130 isolates of S.aureus were obtained from different clinical specimens which included pus/ wound swab (n=266), urine (n=577), sputum (n=225), blood (n=221), throat swab (n=71), ear/eye discharge (n=21), high vaginal swab (n=20) and body fluids (n=50). All the isolates were subjected to antibiotic sensitivity testing by Kirby Bauer’s disc diffusion method. Amoxyclav, Erythromycin, Clindamycin, Co-trimoxazole, Tetracycline, Ofloxacin, Gentamicin, Linezolid and Vancomycin were the antibiotics used.

Results: Out of 130 (8.9%) isolates of S. aureus obtained from 1451 clinical samples, 82 (63.1%) were found to be MSSA and 48 (36.9%) were MRSA. Among S. aureus, 43 (33.1%) isolates showed MLSBc resistance, 22 (16.9%) isolates showed MLSBi resistance and 20 (15.4%) isolates showed MS phenotype. The remaining 45 (34.6%) isolates remained sensitive to Erythromycin. Among MSSA, MLSBc were observed in 18 (22%) isolates and MLSBi in 9 (11%) while in MRSA, MLSBc were observed in 25 (52.1%) isolates and MLSBi in 13 (27.1%) isolates. Almost all clinical isolates showed 100% sensitivity to Vancomycin and Linezolid in routine antibiotic susceptibility testing. Both MLSBc and MLSBi resistance was significantly higher (p<0.05) in MRSA than in MSSA.

Conclusions: The study emphasizes the importance of conducting D test along with routine antibiotic susceptibility testing for better utilization of clindamycin in S. aureus infections.


Keywords


Clindamycin, Constitutive, Inducible, MRSA, MSSA, Phenotype

Full Text:

PDF

References


Lowy FD. Staphylococcus aureus Infections. N Engl J Med. 1998;339:520-32.

Livermore DM. Antibiotic Resistance in Staphylococci. Int J Antimicrob Agents. 2000;16(1):3-10.

Robert C, Moellering Jr. Current treatment options for Community Acquired Methicillin Resistant Staphylococcus aureus infection. Clin Infect Dis. 2008;46(7):1032-7.

Lyall KD, Gupta V, Chhina D. Inducible clindamycin resistance among clinical isolates of Staphylococcus aureus. J Mahatma Gandhi Inst Med Sci. 2013;18(2):112-5.

Fiebelkorn KR, Crawford SA, McElmeel ML, Jorgensen JH. Practical disk Diffusion method for detection of Inducible clindamycin resistance in Staphylococcus aureus and Coagulase-Negative Staphylococci. J Clin Microbiol. 2003;41(10):4740-4.

Jenssen WD, Thakker-Varia S, Dubin DT, Weinstein MP. Prevalence of Macrolides- Lincosamides-Streptogramin B resistance and erm gene classes among clinical strains of Staphylococci and Streptococci. Antimicrob Agents Chemother. 1987;31(6):883-8.

Smieja M. Current indications for the use of clindamycin: A critical review. Can J Infect Dis. 1998;9(1):22-8.

CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement. CLSI document M100-S24, Wayne, PA: Clinical and Laboratory Standards Institute. 2014.

Das PP, Choudhury G, Saikia L. Inducible Clindamycin Resistance in clinical isolates of Staphylococcus aureus. Int J Med Res Prof. 2016;2(1):65-9.

Mokta KK, Verma S, Chauhan D, Ganju SA, Singh D, Kanga A, et al. Inducible clindamycin resistance among clinical isolates of Staphylococcus aureus from Sub Himalayan region of India. J Clin Diag Res. 2015;9(8):20-3.

Mittal V, Kishore S, Siddique ME. Prevalence of inducible clindamycin resistance among clinical isolates of Staphylococcus aureus detected by phenotypic method: A preliminary report. J Infect Dis Immun. 2013;5(1):10-2.

Saffar H, Rajabiani A, Abdollahi A, Habibi S, Baseri Z. Frequency of inducible clindamycin resistance among gram-positive cocci in a tertiary hospital, Tehran, Iran. Iran J Microbiol. 2016;8(4):243-8.

Ghosh S, Banerjee M. Methicillin resistance and inducible clindamycin resistance in Staphylococcus aureus. Indian J Med Res. 2016;143:362-4.

Appalaraju B, Jayakumar S. Inducible Clindamycin Resistance in Staphylococcus aureus isolated from clinical samples. J Commun Dis. 2010;42(4):263-8.

Nikam AP, Bhise PR, Deshmukh MM. Phenotypic detection of inducible clindamycin resistance among Staphylococcus aureus isolates. Int J Res Med Sci. 2017;5(2):543-7.

Khan F, Ali S, Sultan A, Rizvi M, Shukla I. Clindamycin Resistance constitutive and inducible patterns in erythromycin resistant clinical isolates of Staphylococcus species. Int J Microbiol Res. 2014;5(3):185-9.

Lall M, Sahni AK. Prevalence of inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Med J Armed Forces India. 2014;70:43-7.

Vivek JS, Rajesh GN, Mukesh S, Manpreet K, Manpreet K, Misra RN, et al. Prevalence of inducible clindamycin resistance among community- and hospital-associated Staphylococcus aureus isolates in a tertiary care hospital in India. Biomed Res. 2011;22:465–9.

Angel MR, Balaji V, Prakash JAJ, Brahmadathan KN, Mathews MS. Prevalence of inducible clindamycin resistance in Gram positive organisms in a tertiary care centre. Ind J Med Microbiol. 2008;26(3):262-4.

Ahmad FB, Ahmad PM, Danish Z, Ahmad TM, Ahmad NR. Phenotypic detection of constitutive and inducible clindamycin resistance in clinical isolates of Staphylococcus aureus and coagulase negative staphylococcus on routine susceptibility plate. J Commun Dis. 2010;42(1):19-26.

Supriyarajvi, Gupta A, Tina G, Sharma BP. Detection of inducible Clindamycin Resistance among Staphylococcal isolates from various clinical specimens in a tertiary care institute in North west region of Rajasthan, India. Int J Curr Microbiol App Sci. 2015;4(10):741-9.

Satish JV, Janakiram K, Vijaya D. Inducible Clindamycin Resistance in Staphylococcus aureus: Reason for treatment failure. J Int Med Dentistry. 2015;2(2):97-103.

Bhooshan S, Prasad J, Dutta A, Vandana KE, Mukhopadhyay C. Reduced susceptibility of MRSA to Vancomycin. Int J Pharm Pharm Sci. 2016;8(9):321-2.

Roy PC, Shaheduzzaman M, Sultana N, Jahid IK. Comparative antibiotic sensitivity pattern of Hospital and Community acquired Staphylococcus aureus isolates of Jessore, Bangladesh. J Biosciences Med. 2015;3:17-23.

Brown DF, Edwards DI, Hawkey PM, Morrison D, Ridgway GL, Towner KJ, et al. Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). J Antimicrob Chemotherapy. 2015;56:1000-18.

Debnath A, Chikkaswamy BK. Antibiogram and susceptibility pattern of Methicillin-Resistant Staphylococcus aureus collected from various clinical samples in Bengaluru. Asian J Pharm Clin Res. 2015;8(6):260-4.

Mandelia C, Shenoy S. Community associated Methicillin-Resistant Staphylococcus aureus in skin and soft tissue infections. J Clin Diag Res. 2010;4:2673-7.