Spectrum of constitutive and inducible clindamycin resistance in Staphylococcus spp isolated from clinical samples and its relation with methicillin resistance.

  • Monika Rajani Department of Microbiology, Career Institute of Medical Sciences and Hospital, Lucknow,UP,India
  • Malay Banerjee Department of Microbiology, Career Institute of Medical Sciences and Hospital, Lucknow,UP,India
Keywords: Clindamycin resistance, Constitutive and inducible clindamycin resistance, Macrolide-lincosamide-streptogramin(MLS), Methicillin-resistance, D-test

Abstract

Backgound: Increasing Staphylococcal infections with changing patterns of antimicrobial resistance has led to renewed interest in macrolide-lincosamide-streptogramin group B (MLSB) antibiotic. Misuse of MLSB antibiotics has increased resistance of Staphylococcusspp. to these drugs. Failure to detect inducible clindamycin resistance leads to therapeutic failure.Determine the prevalence of constitutive and inducible clindamycin resistance in clinical isolates of Staphylococcus spp. Ascertain the relationship between methicillin-resistance in Staphylococcus spp with constitutive and inducible clindamycin resistance.Methods:  Prospective study was carried over a period of six months with 722 clinical specimens. A total of 184 Staphylococcal isolates were identified.  Staphylococcal isolates were speciated as S aureus, S epidermidis and S saprophyticus. Antibiotic susceptibility testing was done by Kirby-Bauer’s disc diffusion method using cefoxitin, erythromycin, and clindamycin. A disc approximation test was performed for detection of inducible clindamycin resistance for all strains resistant to erythromycin but sensitive to clindamycin.Results: Out of 184 staphylococcal isolates, 128 (69.5%) S aureus and 56 (30.4%) Coagulase negative Staphylococcus spp were identified. 114 (61.9%) of the isolates were susceptible to both clindamycin and erythromycin. Overall 70 (38.04%) isolates were resistant to erythromycin. Out of these,38 (54.2%%) of strains depicted cMLSB phenotype being resistant to both erythromycin and clindamycin.20 (28.5%) isolates showed inducible clindamycin resistance while 12(17.1%) isolates indicated MS phenotype. Percentage of both constitutive and inducible clindamycin resistance was found to be higher in methicillin resistant staphylococcal isolates than methicillin sensitive isolates.Conclusions: We recommend that the clinical microbiology laboratories should test the isolates for inducible clindamycin resistance by D test, for all isolates that appear erythromycin resistant and clindamycin susceptible in vitro.

Author Biography

Monika Rajani, Department of Microbiology, Career Institute of Medical Sciences and Hospital, Lucknow,UP,India
Assistant Prof, Department of Microbiology, Career Institute of Medical Sciences and Hospital, Lucknow,UP,India

References

1. Timothy Foster. Staphylococcus. In: Medical Microbiology; 4th edition: Galveston (TX): University of Texas Medical Branch at Galveston;1996.p.1-12.

2. Richard R. Watkins, Michael Z. David, and Robert A. Salata. Current concepts on the virulence mechanisms of methicillin resistant Staphylococcus aureus. J Med Microbiol. 2012Sep;61:1179–1193.

3. Sasirekha B, Usha MS, Amruta JA, Ankit S, Brinda N, Divya R.Incidence of constitutive and inducible clindamycin resistance among hospital-associated Staphylococcus aureus.3 Biotech. 2014;4(1):85-89.

4. Vivek JS, Rajesh GN, Mukesh S, Manpreet K, Misra RN, Matnani GB et al. The prevalence of inducible clindamycin resistance among community-and hospital-associated Staphylococcus aureus isolates in a tertiary care hospital in India. Biomedical Res 2011; 22:465-469.

5. Juyal D, Shamanth AS, Pal S, Sharma MK, Prakash R, Sharma N.The prevalence of inducible clindamycin resistance among staphylococci in a tertiary care hospital - a study from the garhwal hills of uttarakhand, India.J Clin Diagn Res. 2013;7(1):61-5.

6. Kiran K. Mokta et al., Inducible Clindamycin Resistance among Methicillin Resistant and Methicillin Susceptible Strains of Staphylococcus aureus. Journal of Clinical and Diagnostic Research. 2015,9(8): p20-23.

7. Roland LeclercqMechanisms of Resistance to Macrolides and Lincosamides: Nature of the Resistance Elements and Their Clinical Implications .Clin Infect Dis.2002: 482-492.

8. Prabhu K, Rao S, and Rao V.Inducible Clindamycin Resistance in Staphylococcus aureus Isolated from Clinical Samples. J Lab Physicians. 2011; 3(1): 25–27.

9. KE Vandana, Singh J, M Chiranjay, and Indira Bairy.Inducible Clindamycin Resistance in Staphylococcus aureus: Reason for Treatment Failure. J Glob Infect Dis. 2009;1(1): 76–77.

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

11. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial Susceptibility testing, 17th informational supplement (M100-517). 2015, Wayne Pa: Clinical and Laboratory Standards Institute.

12.Baird D.Staphylococcus:Cluster forming Gram –positive cocci. In:Mackie & McCartney,Practical Medical Microbiology.14th edition.pp245-261.

13.PrestonHowardBlomquist.Methicilli resistant staphylococcus aureus infections of the eye and orbit (an american ophthalmological society thesis). Trans Am Ophthalmol Soc. 2006 Dec; 104: 322–345.

14. Pramodhini S., Thenmozhivalli P.R., Selvi R., Dillirani V., Vasumathi A., Agatha D. comparison of various phenotypic methods and mec A based PCR for the detection of MRSA. Journal of Clinical and Diagnostic Research ,2011; 5:1359-1362.

15. Brumfitt W and Hamilton‐Miller J. Methicillin‐resistant Staphylococcus aureus. N. Engl. J. Med. 1989; 320:1188‐1196.

16.Bansidhar Tarai, Poonam Das, and Dilip Kumar.Recurrent Challenges for Clinicians: Emergence of Methicillin-Resistant Staphylococcus aureus, Vancomycin Resistance, and Current Treatment Options . J Lab Physicians. 2013 Jul-Dec; 5(2): 71–78.

17. Kaur DC and Sanjay S Chate.Study of Antibiotic Resistance Pattern in Methicillin Resistant Staphylococcus Aureus with Special Reference to Newer Antibiotics. J Glob Infect Dis. 2015 Apr-Jun; 7(2): 78–84.

18.Rayner C1, Munckhof WJ.Antibiotics currently used in the treatment of infections caused by Staphylococcus aureus. . Intern Med J. 2005 Dec;35 Suppl 2:S3-16.

19. Deotale V, Mendiratta DK, Raut U, Narang P. Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Ind J Med Microbiol. 2010;28:124-6.

20. Gadepalli R, Dhawan B, Mohantay S, Kapil A, Das BK, Chaudhary R. Inducible clindamycin resistance in clinical isolates of Staphylococcus aureus. Indian J Med Res. 2006;123:571–73.

21. Gupta V, Datta P, Rani H, Chander J. Inducible clindamycin resistance in Staphylococcus aureus: A study from north india. J Postgrad Med. 2009;55:176–79.

22. Ajantha GS, Kulkarni RD, Shetty J, Shubhada C, Jain P. Phenotypic detection of inducible clindamycin resistance among Staphylococcus aureus isolates by using the lower limit of recommended inter-disk distance. Indian J Pathol Microbiol 2008;51:376-8.

23. Azap OK, Arslan H, Timurkaynak F, Yapar G, Oruc E, Gagir U. Incidence of inducible clindamycin resistance in erythromycin-resistant isolates of Staphylococcus aureus. J Clin Microbiol. 2005;43:1716–24.

24. Yilmaz G, Aydin K, Iskender S, Calyan R, Koksal I. Detection and prevalence of inducible clindamycin resitance in staphylococci. J med Microbiol. 2007;56:342–45.

25. Farooq S, Saleem M. Prevalence of constitutive and inducible clindamycin resistance among clinical isolates of staph aureus in Kashmir valley: a hospital based study. J. Evolution Med. Dent. Sci. 2016; 5(17):828-831.

26. Ciraj A M, Vinod P, Sreejith G, Rajani K. Inducible clindamycin resistance among clinical isolates of staphylococci. Indian J Pathol Microbiol 2009;52:49-51.

27. Braun L, Craft D, Williams R, Tuamokumo F, Ottolini M. Increasing clindamycin resistance among methicillin resistant Staphylococcus aureus in 57 northeast United States military treatment facilities. Pediatr Infect Dis J 2005;24:622-6.

28. Fokas, S. Fokas, M. Tsironi, M. Kalkani, M. Dionysopouloy.Prevalence of inducible clindamycin resistance in macrolide-resistant Staphylococcus spp.Clin Microbiol Infect, 11 (2005), pp. 337–340

29. Ajantha GS, Kulkarni RD, Shetty J, Shubhada C, Jain P. Phenotypic detection of inducible clindamycin resistance amongst Staphylococcus aureus isolates by using lower limit of recommended inter-disk distance. Indian J Pathol Microbiol. 2008;51:376–8.

30. Parasa LS, Tumati SR. Prevalence of induced clindamycin resistance in methicillin resistant Staphylococcus aureus from hospital population of coastal Andhara pradesh,South india.Archives of clinical microbiology. 2011;2( 1).
Published
2017-12-19
Issue
Vol 4 No 6 (2017)
Section
Original Article

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