Articles

Inducible clindamycin resistance in Staphylococcus aureus isolates recovered from Mashhad, Iran

Abstract

Background and Objectives: Staphylococcus aureus is an important agent in hospital and community-associated infections, causing high morbidity and mortality. Introduction of the new antimicrobial classes for this pathogen has been usually followed by the emergence of resistant strains through multiple mechanisms. For instance, resistance to clindamycin (CLI) can be constitutive or inducible. Inducible clindamycin resistance which may lead to treatment failure can simply be identified by performing D-test. The aim of this study was to determine the prevalence of inducible clindamycin resistance among Staphylococcus aureus isolates by D-test method.
Materials and Methods: This was a cross-sectional study conducted on 211 non-duplicated S. aureus isolates in Imam Reza hospital of Mashhad during 2010. Susceptibility to oxacillin, cefoxitin, erythromycin and clindamycin was performed by agar disk diffusion method according to CLSI guidelines and D-shaped clindamycin susceptibility patterns where considered as D-test positive (D+).
Results: Of 211 S. aureus isolates, 88 (41.7%) were methicillin resistant. It was found that of 88 MRSA isolates, 78 (88.6%)were erythromycin (ERY) resistant and 46 (52.3%) were CLI resistant. ERY and CLI resistance in MSSA strains was 22% and 11.4% respectively. Inducible clindamycin resistance was detected in 18 (20.5%) MRSA isolates, 46 ( 52.3%) of MRSA isolates and 9 (7.3%) of MSSA showed constitutive MLS phenotype.
Conclusion: In conclusion, we found a high prevalence of inducible clindamycin resistance phenotype in our region. We recommend that whenever clindamycin is intended to be used for S. aureus infections, D-test should be performed to facilitate the appropriate treatment of patients.

Prabhu K, Rao S, Rao V. Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. J Lab Physicians 2011; 3: 25-7.

Saderi H, Owlia P, Eslami M. Prevalence of Macrolide- Lincosamide-Streptogamin B (MLS ) resistance in S. aureus isolated from patients in Tehran, Iran. Iran J Pathol 2009; 4: 161-166.

Yilmaz G, Aydin K, Iskender S, Caylan R, Koksal I. Detection and prevalence of inducible clindamycin resistance in staphylococci. J Med Microbiol 2007; 56: 342-345.

Office for national statistics (2011) Deaths involving MRSA: England and Wales, 2006 to 2010. Accessed 23 August 2011. Available at: www.ons.gov.uk/ons/ rel/subnational-health2/deaths-involving-mrsa/2006-to- 010/statistical-bulletin.html.

Cosgrove SE, Qi Y, Kaye KS, Harbarth S,Karchmer AW, Carmeli Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005; 26: 166-174.

Sedighi I, Mashouf RY, Pak N, Rabiee MAS. D-Test Method for Detection of Inducible Clindamycin Resistance in Staphylococcus aureus. Iran J Pediatr 2009; 19: 293-297.

Kluytmans J, van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms and associated risks. Clin Microbiol Rev 1997; 10: 505.

Emaneini M, Eslampour MA, Sedaghat H, Aligholi M, Jabalameli F, Shahsavan S, et al. Characterization of phenotypic and genotypic inducible macrolide resistance in staphylococci in Tehran, Iran. J Chemother 2009; 21: 595-597.

Feibelkorn KR, Crawford SA, McElmeel ML, Jorgenson JH. Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci. J Clin Microbiol 2003; 41: 4740-4744.

Zorgani A, Shawerf O, Tawil K, El- Turkey E,Gheghesh KS. Inducible clindamycin resistance among staphylococci isolated from burn patients. Libyan J Med 2009; 4: 104-106.

Mohanasoundaram KM. The prevalence of inducible clindamycin resistance among gram positive cocci from various clinical specimens. JCDR 2011; 5: 38-40.

Leclercq R. Mechanism of resistance to macrolides and lincosamides: naure of resistance elements and their clinical implications. Clin Infect Dis 2002; 34: 482-492.

Siberry GK, Tekle T, Carrol K, Dick J. Failure of clindamycin treatment of methicillin resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clin Infect Dis 2003; 37: 1257-1260.

Clinical and Laboratory standards institute. Performance standard for antimicrobial susceptibility testing; nine- teen informational supplement M100-S19.Wayne, PA: CLSI 2009.

Pai V, Rao VI, Rao SP. Prevalence and antimicrobial susceptibility pattern of methicillin resistant Staphylo- coccus aureus isolates at a tertiary care hospital in Mangalore, South India. J Lab Physicians. 2010; 2: 82-84.

Shoja S, Nahaei MR, Nahaei M. Detection of inducible clidamycin resistance in Staphylococcus aureus and Staphylococcus epidermidis by using D-Test. Pharmacol Sci 2009; 15: 1-8.

Ekrami A, Samarbafzadeh A, Alavi M, Kalantar E, Hamzeloi F. Prevalence of methicillin resistant Staphylococcus species isolated from burn patients in a burn center, Ahvaz, Iran. Jundishapur J Microbiol 2010; 3: 84-91.

Debdas D, Joshi S. Incidence of clindamycin resistance in clinical isolates of Staphylococcus aureus. J Infect Dev Ctries 2011; 5: 316-317.

Pillar CM, Draghi DC, Sheehan DJ, Sahm DF.Prevalence of multidrug-resistant, methicillin-resistant Staphylococcus aureus in the United States: findings of the stratified analysis of the 2004 to 2005 LEADER Surveillance Programs. Diagn Microbiol Infect Dis 2008; 60: 221-224.

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; 20: 1-6.

Naderinasab M, Yousefi F, Farshadzadeh Z, Sasan M. Determine the Inducible Resistance Phenotype in Methicillin Resistance Staphylococcus aureus and Coagulase Negative Staphylococci. Iran J Med Microbiol 2007; 1: 25-31.

Saderi H, Emadi B, Owlia P. Phenotypic and genotypic study of macrolide, lincosamide and streptogramin B (MLSB) resistance in clinical isolates of Staphylococcus aureus in Tehran, Iran. Med Sci Monit 2011; 17: 48-53.

Memariani M, Pourmand MR, Shirazi MH, Abdossamadi Z, Mardani N. The importance of inducible clindamycin resistance in enterotoxin positive S. aureus isolated from clinical samples. Tehran Univ Med J 2009; 67: 250-256.

Rahbar M, Hajia M. Inducible Clindamycin Resistance in Staphylococcus aureus: A Cross-Sectional Report. Pakistan J Biol Sci 2007; 10: 189-192.

Nafisi MR, Shariati L, Validi M, Karimi A. Prevalence of constitutive and inducible resistance to clindamycin in staphylococci isolates from Hajar and Kashani hospitals in Shahrekord, 2008. J Shahrekord Univ Med Sci 2010;12: 13-20.

Chavez-Bueno S, Bozdogan B, Katz K, Bowlware KL, Cushion N, Cavuoti D, et al. Inducible clindamycin resistance and molecular epidemiologic trends of pediatric community-acquired methicillin-resistant Staphylococcus aureus in Dallas, Texas. Antimicrob Agents Chemother 2005; 49: 2283-2288.

Lavallee C, Rouleau D, Gaudreau C, Roger M, Tsimiklis C, Locas MC, et al. Performance of an agar dilution method and a Vitek 2 Card for detection of inducible clindamycin resistance in Staphylococcus spp. J Clin Microbiol 2010; 48: 1354-1357.

Schreckenberger PC, Ilendo E, Ristow KL. Incidence of constitutive and inducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci in a community and a tertiary care hospital. J Clin Microbiol 2004; 42: 2777-2779.

Files
IssueVol 4 No 2 (2012) QRcode
SectionArticles
Keywords
Inducible resistance Staphylococcus aureus clindamycin

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Seifi N, Kahani N, Askari E, Mahdipour S, Naderi-Nasab M. Inducible clindamycin resistance in Staphylococcus aureus isolates recovered from Mashhad, Iran. Iran J Microbiol. 1;4(2):82-86.