Abstract
The increasing incidence of methicillin resistance among Staphylococci has led to renewed interest in the usage of macrolide-lincosamide-streptogramin B (MLSB) antibiotics to treat S. aureus infections, with clindamycin being the preferable agent owing to its excellent pharmacokinetic properties. Inducible clindamycin resistance my lead to therapeutic failure. Detection of the prevalence of constitutive and inducible clindamycin resistance in clinical isolates of S. aureus to improve the clinical outcomes in patients. A total of 176 non-duplicate staphylococcal isolates were isolated from different clinical samples. Methicillin resistance was detected using Cefoxitin disk diffusion (CDD) method. Phenotypic clindamycin resistance was performed for all isolates by D test. Polymerase Chain Reaction (PCR) assay were done for detection of erm resistance genes (ermA, ermB and ermC). Out of 176 strains of S. aureus, 108 isolates (61.3%) were identified as MRSA. Erythromycin and clindamycin resistance was detected in 96 isolates (54.5%) and 68 isolates (38.6%) respectively. Clindamycin resistance (cMLSB) was significantly higher (p value < 0.001) in MRSA strains (56 isolates) compared to MSSA (12 isolates). Resistant genes were detected in 160 isolates (91%). The ermA gene was detected in 28 isolates (16%), the ermB gene was detected in 80 isolates (45.5%) (p < 0.001). The frequency of constitutive and inducible clindamycin resistance in MRSA isolates emphasizes the need to use D test in routine antimicrobial susceptibility testing to detect the susceptibility to clindamycin as the inducible resistance phenotype can inhibit the action of clindamycin and affect the treatment efficacy.
Highlights
The increasing incidence of methicillin resistance among Staphylococci has led to renewed interest in the usage of macrolidelincosamide-streptogramin B (MLSB) antibiotics to treat S. aureus infections, with clindamycin being the preferable agent owing to its excellent pharmacokinetic properties
Increasing frequency of Methicillin Resistant Staphylococcus aureus (MRSA) and changing the pattern of antimicrobial resistance decreases the therapeutic options to treat these infections and force the physician to change the pattern of prescribed antimicrobials and use of macrolidelincosamide-streptogramin group B (MLSB) [2,3]
MLSB antibiotics resistant strains emergence due to the misuse of these antibiotics has been reported as a new challenge in treating such infections [4,21]
Summary
The increasing incidence of methicillin resistance among Staphylococci has led to renewed interest in the usage of macrolidelincosamide-streptogramin B (MLSB) antibiotics to treat S. aureus infections, with clindamycin being the preferable agent owing to its excellent pharmacokinetic properties. Conclusions and recommendations: The frequency of constitutive and inducible clindamycin resistance in MRSA isolates emphasizes the need to use D test in routine antimicrobial susceptibility testing to detect the susceptibility to clindamycin as the inducible resistance phenotype can inhibit the action of clindamycin and affect the treatment efficacy. Increasing frequency of Methicillin Resistant Staphylococcus aureus (MRSA) and changing the pattern of antimicrobial resistance decreases the therapeutic options to treat these infections and force the physician to change the pattern of prescribed antimicrobials and use of macrolidelincosamide-streptogramin group B (MLSB) [2,3]. Modification of the target site, efflux pump and drug inactivation are the main mechanisms of macrolide and lincosamide resistance in clinical isolates
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