DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20195541

Detection of inducible clindamycin resistance in Staphylococcus aureus from various samples in a tertiary care hospital

Rohit Kumar, Jagarti ., Mrinmoy Sarma, Gautam Shalini

Abstract


Background: The increasing frequency of MRSA infections and rapidly changing patterns in antimicrobial resistance, led to renewed interest in the usage of Macrolides-Lincosamide-Streptogramin B (MLSB) antibiotics to treat Staphylococcus aureus infection. Clindamycin is an important drug used in the treatment of MRSA and MSSA infection. The aim of this study was to determine inducible and constitutive clindamycin resistance among clinical isolates of Staphylococcus aureus by D-test.

Methods: During a period of 6 months from July 2018 to December 2018, a total of 100 Staphylococcus aureus isolated from different clinical samples were subjected to routine antibiotic sensitivity testing by Kirby Bauer’s disc diffusion method. Methicillin-resistance was determined by using the cefoxitin (30 µg) disc. Incidence of MLSBc and MLSBi in Staphylococcus aureus isolates by D-test as per CLSI guidelines.

Results: Out of 100 isolates of Staphylococcus aureus obtained from 350 clinical samples, 70(70%) were found to be MRSA and 30(30%) were MSSA. Among 100 Staphylococcus aureus isolates, 40% isolates showed MLSBi resistance, 28% isolates showed MLSBc resistance, 6% isolates showed MS phenotype and 26% isolates showed Sensitive phenotype. MLSBc and MLSBi were found to be higher in MRSA as compared to MSSA (21%, 27% and 7%, 10% respectively). All clinical isolates showed 100% sensitivity to Vancomycin and Linezolid in routine antibiotic susceptibility testing.

Conclusions: Continuous surveillance of the MLSB resistance is important and required before the prescription of clindamycin to treat MRSA infections.


Keywords


D-test, Inducible clindamycin resistance, Methicillin-resistant Staphylococcus aureus, Staphylococcus aureus

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References


Lall M, Sahni AK. Prevalence of inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Medica J Armed Forces Ind. 2014 Jan 1;70(1):43-7.

Washington W, Allen S, Janda W, Koneman E, Procop G, Schrekenberger P. Taxanomy of Staphylococci and related Gram-Positive Cocci, clinical significance of Staphylococci and related Gram Positive Cocci. Koneman’s Color Atlas and Text book of practical Microbiology; 6th Ed. USA 2007.

Chambers HF. The changing epidemiology of Staphylococcus aureus?. Emerging Infect Dis. 2001 Mar;7(2):178-82.

Jevons MP. “Celbenin”-resistant staphylococci. British Medica J. 1961 Jan 14;1(5219):124.

Pai V, Rao VI, Rao SP. Prevalence and antimicrobial susceptibility pattern on methicillin resistant Staphylococcous aureus [MRSA] isolates at a tertiary care hospital in Mangalore, South India, J Lab Phys. 2010;2:82-4.

Fasih N, Irfan S, Zafar A, Khan E, Hasan R. Inducible clindamycin resistance due to expression of erm genes in Staphylococcus aureus: report from a tertiary care hospital Karachi, Pakistan. J Pakistan Medica Assoc. 2010;60(9):750-3.

Kaur DC, Khare AS. Inducible clindamycin resistance in Staphylococcus aureus in a tertiary care rural hospital. Indian J Basic Appl Med Res. 2013;2:686‑93.

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;41:4740-4.

Kasten MJ. Clindamycin, metronidazole and chloramphenicol. Mayo Clinc Proc. 1999;74:825-33.

Chelae S, Laohaprertthisarn V, Phengmak M, Kongmuang U, Kalnauwakul S. Detection of inducible clindamycin resistance in Staphylococci by disc diffusion induction test. J Med Assoc Thai. 2009; 92(7):947-51.

Leclercq R. Mechanisms of resistance to macrolides and lincosamides: nature of the resistance elements and their clinical implications. Clini Infect Dis. 2002 Feb 15;34(4):482-92.

Siberry GK, Tekle T, Carroll K, Dick J. Failure of clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clini Infect Dis. 2003 Nov 1;37(9):1257-60.

Koneman’s. Color atlas and textbook of Diagnostic microbiology. 6th edition.983-987.

Drinkovic D, Fuller ER, Shore KP, Holland DJ, Ellis-Pegler R. Clindamycin treatment of Staphylococcus aureus expressing inducible clindamycin resistance. J Antimicro Chemo. 2001 Aug 1;48(2):315-6.

Yilmaz G, Aydin K, Iskender S, Caylan R, Koksal I. Detection and prevalence of inducible clindamycin resistance in staphylococci. J Medica Microbiol. 2007 Mar 1;56(3):342-5.

Jarajreh DA, Aqel A, Alzoubi H, Al-Zereini W. Prevalence of inducible clindamycin resistance in methicillin-resistant Staphylococcus aureus: the first study in Jordan. J Infect Developing Countries. 2017 Apr 30;11(04):350-4.

Dubey D, Rath S, Sahu MC, Rout S, Debata NK, Padhy RN. A report on infection dynamics of inducible clindamycin resistance of Staphylococcus aureus isolated from a teaching hospital in India. Asian Pacific J Tropic Biomed. 2013 Feb 1;3(2):148-53.

Rao AVR, Kavitha A, Seetha KS. Prevalence of inducible clindamycin resistance among clinical isolates of staphylococci. Nat J Basic Medica Sci. 2012;3(1):68-71.

Seifi N, Kahani N, Askari E, Mahdipour S, Naderi Nasab M. Inducible clindamycin resistance in Staphylococcus aureus isolates recovered from Mashhad, Iran. Iranian J Microbiol. 2012;4(2):82-6.

Eksi F, Gayyurhan ED, Bayram A, Karsligil T. Determination of antimicrobial susceptibility patterns and inducible clindamycin resistance in Staphylococcus aureus strains recovered from southeastern Turkey. J Microbiol, Immunol Infect. 2011 Feb 1;44(1):57-62.

Rajaduraipandi K, Mani KR, Panneerselvam K, Mani M, Bhaskar M, Manikandan P. Prevalence and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus: A multicentre study. Indian J Medica Microbiol. 2006 Jan 1;24(1):34-8.

Tyagi A, Kapil A, Singh P. Incidence of Methicillin Resistant Staphylococcus aureus [MRSA] in Pus Samples at a Tertiary Care Hospital, AIIMS, New Delhi. JIACM. 2008; 9:33-5.

Tiwari HK, Das AK, Sapkota D, Sivrajan K, Pahwa VK. Methicillin resistant Staphylococcus aureus: prevalence and antibiogram in a tertiary care hospital in western Nepal. J Infect Developing Countries. 2009 Oct 22;3(09):681-4.

Tiwari HK, Sen MR. Emergence of vancomycin resistant Staphylococcus aureus (VRSA) from a tertiary care hospital from northern part of India. BMC Infect Dis. 2006 Dec;6(1):156.

Perwaiz S, Barakzi Q, Farooqi BJ, Khursheed N, Sabir N. Antimicrobial susceptibility pattern of clinical isolates of methicillin resistant Staphylococcus aureus. J Pak Medica Assoc. 2007 Jan;57(1):2.

Sanjana RK, Shah R, Chaudhary N, Singh YI. Prevalence and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) in CMS-teaching hospital: a preliminary report. J College Medica Sci-Nepal. 2010;6(1):1-6.

Gupta YK, Gupta G, Garg SP, Nirwan PS. Prevalence and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus isolated at a tertiary care institute in northwest region of Rajasthan. Int. Res J Pharm. App Sci., 2013; 3(6):13-16.

Sreenivasulu RP, Suresh R. Phenotypic detection of Inducible Clindamycin resistance among the clinical isolates of Staphylococcus aureus by using the lower limit of inter disk space. J Microbiol Biotech Res. 2012, 2 (2):258-64.

Patil NR, Mali US, Kulkarni SA, Ghorpade MV, Vijay Mane. Detection of inducible clindamycin resistance among clinical isolates of Staphylococcus aureus in a tertiary care hospital. Int J Curr Microbiol App Sci. 2014;3(9):689-94.

Dalela G, Vijay A, Joshi M. Phenotypic Expression of erm Gene Among Staphylococcus aureus. Nat J Lab Med. 2016 Apr;5(2):25-9.

Jethwani UN, Mulla SA, Shah LN. Detection of inducible clindamycin resistance by an automated system in a tertiary care hospital. African J Microbiol Res. 2011 Sep 16;5(18):2870-2.

Date K, Choudhary M, Thombare V. Inducible clindamycin resistance in clinical isolates of staphylococci in a rural hospital. Int J Biol Med Res. 2012; 3(3): 1922-5.

Dizbay M, Günal O, Ozkan Y, Ozcan DK, Altunçekiç A, Arman D. Constitutive and inducible clindamycin resistance among nosocomially acquired staphylococci. Mikrobiyoloji bulteni. 2008 Apr;42(2):217-21.

Saderi H, Owlia P, Eslami M. Prevalence of Macrolide-Lincosamide-Streptogramin B (MLSB) resistance in S. aureus isolated from patients in Tehran, Iran. Iran J Pathol. 2009 Sep 1;4(4):161-6.

Adhikari RP, Shrestha S, Barakoti A, Amatya R. Inducible clindamycin and methicillin resistant Staphylococcus aureus in a tertiary care hospital, Kathmandu, Nepal. BMC Infect Dis. 2017 Dec;17(1):483.

Singh T, Deshmukh AB, Chitnis V, Bajpai T. Inducible clindamycin resistance among the clinical isolates of Staphylococcus aureus in a tertiary care hospital. Inter J Health Allied Sci. 2016 Apr 1;5(2):111-4.

Angel MR, Balaji V, Prakash JA, Brahmadathan KN, Mathews MS. Prevalence of inducible clindamycin resistance in gram positive organisms in a tertiary care centre. Ind J Medica Microbiol. 2008 Jul 1;26(3):262-4.