Spectrum of constitutive and inducible clindamycin resistance in Staphylococcus spp isolated from clinical samples and its relation with methicillin resistance.
Keywords:
Clindamycin resistance, Constitutive and inducible clindamycin resistance, Macrolide-lincosamide-streptogramin(MLS), Methicillin-resistance, D-testAbstract
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.
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