Abstract
The resistance to MLSB antibiotics, i.e. Macrolide-Lincosamide-Streptogramin B (MLSB), is an increasing problem among Methicillin-resistant Staphylococci. The resistance to macrolides can be by efflux mechanism or via inducible or constitutive resistance. Unfortunately, routine clindamycin susceptibility testing fails to detect the inducible resistance, which commonly results in treatment failure and necessitates incorporating a simple D-test to detect such resistance. A retrospective observational study was performed on S. aureus isolates from patients. The strains were subjected to antibiotic susceptibility testing followed by detection of mecA gene by a polymerase chain reaction and, the ‘D-test’ was performed to know the inducible resistance to clindamycin. A total of 235 isolates were identified as S. aureus. Antibiotic susceptibility test indicated 190 MRSA and 45 are sensitive to MLSB (MS). Inducible clindamycin resistance was found among 48 (20.4%) isolates and constitutive resistance in 104 (44.2%). MRSA strains had higher inducible and constitutive resistance than MSSA strains (22.1%, 51.6% and 13.3%, 13.3%, respectively). Clindamycin is a commonly used antibiotic in patients with MRSA infections to spare higher-end anti-MRSA antibiotics like linezolid and vancomycin. To detect inducible clindamycin to avoid treatment failures; the study showed the importance of incorporating the D-test in routine testing.
Highlights
Skin and soft tissue infections, if not appropriately treated, may lead to disfiguring, amputation, sepsis and extended hospital stays which results in a significant increase in mortality and morbidity rates across the world
A variety of micro-organisms can be associated with skin and soft tissue infections, Staphylococcus aureus being the commonest isolate.1,2 b-lactam group of antibiotics is the most commonly used antibiotic for the treatment of Staphylococcus aureus infections
The macrolide-lincosamide-streptogramin B (MLSB) antibiotics are commonly used to treat Methicillin-resistant S. aureus (MRSA) infections, and among them, the use of clindamycin as an alternative therapy has risen in India and other parts of the world
Summary
Skin and soft tissue infections, if not appropriately treated, may lead to disfiguring, amputation, sepsis and extended hospital stays which results in a significant increase in mortality and morbidity rates across the world. A variety of micro-organisms can be associated with skin and soft tissue infections, Staphylococcus aureus being the commonest isolate. b-lactam group of antibiotics is the most commonly used antibiotic for the treatment of Staphylococcus aureus infections.. Methicillin-resistant S. aureus (MRSA) poses severe therapeutic challenges. A steep rise has been observed in methicillin-resistant S. aureus isolates.. The macrolide-lincosamide-streptogramin B (MLSB) antibiotics are commonly used to treat MRSA infections, and among them, the use of clindamycin as an alternative therapy has risen in India and other parts of the world.. Its increased use has resulted in widespread resistance against clindamycin The macrolide-lincosamide-streptogramin B (MLSB) antibiotics are commonly used to treat MRSA infections, and among them, the use of clindamycin as an alternative therapy has risen in India and other parts of the world. The advantages of choosing clindamycin are—availablility of both parenteral and oral formulations, high bioavailability, soft tissue permeability, inhibits toxin production, and is relatively cheap. its increased use has resulted in widespread resistance against clindamycin
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