Phenotypic detection and incidence of inducible clindamycin resistance among Staphylococcus aureus from tertiary care hospital

Authors

  • Suvarna Vaibhav Sande (Tathe) Department of Microbiology, Jawaharlal Nehru Medical College, Wardha-442004, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20150557

Keywords:

Staphylococcus aureus, D test, Inducible clindamycin resistance

Abstract

Background: Among few therapeutic alternatives available for treatment of erythromycin resistant Staphylococcus aureus infections, clindamycin has several advantages but major barrier in its usage is development of resistance especially inducible resistance due to erm genes resulting in treatment failure. In vitro routine tests for clindamycin susceptibility may fail to detect such resistance which can be detected by simple D test. Hence the present study was undertaken to detect incidence of inducible resistance to clindamycin in erythromycin resistant S. aureus isolates by D test and to study the relationship between clindamycin and methicillin resistance.

Methods: 330 S. aureus isolates were subjected to routine antimicrobial susceptibility test by Kirby-Bauer’s disc diffusion method using various antimicrobial agents. Erythromycin resistant isolates were studied for detection of inducible and constitutive clindamycin resistance by D test according to CLSI guidelines.

Results: Out of 152 erythromycin resistant S. aureus, 46 (30.2%) isolates showed inducible clindamycin resistance, 54 (35.5%) showed constitutive resistance while 52 (34.2%) showed MS phenotype. The percentage of inducible and constitutive resistance was more among MRSA (33.3% and 46.6%) than MSSA (25% and 19.3%) while the percentage of MS phenotype was more among MSSA (54.8%) than MRSA (20%).

Conclusions: D test should be used in routine disc diffusion testing for the detection of inducible clindamycin resistance for the proper treatment of the patient. 

References

Leclercq R. Mechanisms of resistance to macrolides and lincosamides: nature of the resistance elements and their clinical implications. Clin Infect Dis. 2002;34:482-92.

Weisblum B. Erythromycin resistance by ribosome modification. Antimicrob Agents Chemother. 1995;39:577-85.

Weisblum B, Demohn V. Erythromycin-inducible resistance in Staphylococcus aureus: survey of antibiotic classes involved. J Bacteriol. 1969;98:447-52.

Steward CD, Raney PM, Morrell AK, Williams PP, McDougal LK, Jevitt L, et al. Testing for induction of clindamycin resistance in erythromycin resistant isolates of Staphylococcus aureus. J Clin Microbiol. 2005;43:1716-21.

Colle JG, Fraser AG, Marmion BP, Simmmons A. Mackie and McCartney, practical medical microbiology. In: Colle JG, Fraser AG, Marmion BP, Simmmons A, eds. A Book. 14th ed. Amsterdam: Elsevier; 2006.

Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; Twenty second informational supplement. Wayne, PA: CLSI; 2012: CLSI document M100-S22, 32(3).

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.

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

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.

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

Pal N, Sharma B, Sharma R, Vyas L. Detection of inducible clindamycin resistance among staphylococcal isolates from different clinical specimens in Western India. J Postgrad Med. 2010;56:182-5.

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

Ajanta GS, Kulkarni RD, Shetty J, Shukhada C, Jain P. Phenotypic detection of Inducible clindamycin resistanceamong S. aureus isolates by using the lower limit of recommended inter disk distance. Indian J Pathol Microbiol. 2008;51(3):376-8.

Goyal R, Singh NP, Manchanda V, Mathur M. Detection of clindamycin susceptibility in macrolide resistant phenotypes of Staphylococcus aureus. Indian J Med Microbiol. 2004;22:251-4.

Ciraj AM, Vinod P, Sreejith G, Rajani K. Inducible clindamycin resistance among clinical isolates of staphylococci. Indian J Pathol Microbiol. 2009;52:49-51.5.

Steward CD, Raney PM, Morrell AK, Williams PP, McDougal LK, Jevitt L, et al. Testing for induction of clindamycin resistance in erythromycin-resistant isolates of Staphylococcus aureus. J Clin Microbiol. 2005;43:1716-21.

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;42:2777-9.

Patil N, Mali U, Kulkarni S, Ghorpade M, ManeV. 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.

Gadepalli R, Dhawan B, Mohanty S, Kapil A, Das BK, Chaudhry R. Inducible clindamycin resistance in clinical isolates of Staphylococcus aureus. Indian J Med Res. 2006;123:571-3.

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

Levin TP, Suh B, Axelrod P, Truant AL, Fekete T. Potential clindamycin resistance in clindamycin-susceptible, erythromycin-resistant Staphylococcus aureus: report of a clinical failure. Antimicrob Agents Chemother. 2005;49:1222.

Shrestha B, Pokhrel BM, Mohapatra TM. Phenotypic characterization of nosocomial isolates of Staphylococcus aureus with reference to MRSA. J Infect Dev Ctries. 2009;3(7):554-60.

Merino L, Torres MJ, Cantos A, Ruiz M, Aznar J. Detection of inducible clindamycin resistance in cutaneous Staphylococci clinical isolates by phenotypic and genotypic method. Copenhagen / Denmark: 15th European Congress of Clinical Microbiology and Infectious Diseases. April 2-5, 2005: Abstract number: 1134_02_427.

Downloads

Published

2017-02-09

Issue

Section

Original Research Articles