Inducible and constitutive clindamycin resistance in Staphylococcus aureus: an experience from Western Nepal

Sah, Prakash; Khanal, Rita; Lamichhane, Pramila; Upadhaya, Sweety; Lamsal, Apsana; Pahwa, V. K.

doi:10.7439/ijbr.v6i5.1959

Cited by 16 publications

(25 citation statements)

References 22 publications

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“…In this study the prevalence of i MLS B among S. aureus was found to be 11.48% which is similar to that reported by Ansari et al (12.4%) [24], Sah et al (12.1%) [14] from Nepal and Govindan et al (11.6%) from India [12]. Varying prevalence rates of i MLS B have been reported in different other studies; 18.2% from Nepal [25] 28.6% from Iran [11], 20.7% [13] and 24.3% [10] from India.…”

Section: Discussionsupporting

confidence: 88%

“…This study showed prevalence rate of 25.1% which is similar to the study done in eastern part of Nepal [21] India [2] and other part of the world [9]. However higher rates of MRSA were also noted in other studies conducted in Nepal [14, 22–24] and other countries [10, 11, 13, 18]. These variations could be due to the differences in the circulating clones or due to the variations in infection prevention practices and trends of antibiotics prescription in different hospital set up.…”

Section: Discussionsupporting

confidence: 87%

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Inducible clindamycin and methicillin resistant Staphylococcus aureus in a tertiary care hospital, Kathmandu, Nepal

et al. 2017

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Background Staphylococcus aureus, an important nosocomial pathogen, is frequently associated with infections in human. The management of the infections by it especially methicillin resistant ones is often difficult because methicillin resistant S. aureus is usually resistant to multiple antibiotics. Macrolide-lincosamide streptogramin B family of antibiotics is commonly used to treat such infections as an alternative to vancomycin.MethodsThis study was conducted over the period of one and half year from November 2013–April 2015 in Microbiology laboratory of Nepal Medical College and Teaching Hospital, Kathmandu, Nepal to find the incidence of different phenotypes of MLSB resistance among S. aureus from clinical samples and their association with methicillin resistance. Two hundred seventy isolates of S. aureus were included in the study. Methicillin resistance was detected by cefoxitin disc diffusion method and inducible clindamycin resistance by erythromycin and clindamycin disc approximation test (D-test).ResultsOf the 270 clinical isolates of S. aureus, 25.1% (68/270) were MRSA. Erythromycin and clindamycin resistance was seen in 54.4% (147/270) and 41.8% (113/270) isolates respectively. Resistance to erythromycin and clindamycin were higher in MRSA as compared to MSSA (erythromycin-resistance: 88.2% Vs 39.1% and clindamycin-resistance: 79.4% Vs 41.8%). The overall prevalence of iMLSB and cMLSB phenotype was 11.48% (31/270) and 29.25% (79/270) respectively. Both iMLSB and cMLSB phenotypes predominated in MRSA strains.ConclusionsDetection rate of MRSA in our study shows the necessity to improve in healthcare practices and to formulate new policy for the control of MRSA infections. Clindamycin resistance in the form of iMLSB and cMLSB especially among MRSA emphasizes the need of D-test to be performed routinely in our set up while using clindamycin as an alternative choice to anti-staphylococcal antibiotics like vancomycin and linezolid in the treatment of staphylococcal infections.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

Inducible clindamycin and methicillin resistant Staphylococcus aureus in a tertiary care hospital, Kathmandu, Nepal

et al. 2017

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“…(54.78%). [ 15 16 17 ] Lyall et al . had reported a very high percentage of MRSA (91.5%) in their study.…”

Section: Discussionmentioning

confidence: 99%

Detection of inducible and constitutive clindamycin resistance among Staphylococcus aureus isolates in a tertiary care hospital, Eastern India

et al. 2016

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Introduction:Clindamycin is an excellent drug for skin and soft tissue Staphylococcus aureus infections, but resistance mediated by inducible macrolide-lincosamide-streptogramin B (iMLSB) phenotype leads to in vivo therapeutic failure even though they may be in vitro susceptible in Kirby–Bauer disk diffusion method.Objective:The study was aimed to detect the prevalence of iMLSB phenotype among S. aureus isolates by double disk approximation test (D-test) in a tertiary care hospital, Eastern India.Materials and Methods:A total of 209 consecutive S. aureus isolates were identified by conventional methods and subjected to antimicrobial susceptibility testing by Kirby–Bauer disk diffusion method. Erythromycin-resistant isolates were tested for D-test.Results:From 1282 clinical specimens, 209 nonrepeated S. aureus isolates were obtained. Majority of isolates 129 (61.7%) were methicillin-resistant S. aureus (MRSA). There was statistically significant difference between outpatients 60.1% and inpatients 39.9% (P < 0.0001). From 209 S. aureus isolates, 46 (22%) were D-test positive (iMLSB phenotype), 41 (19.6%) were D-test negative (methicillin sensitive [MS] phenotype), and 37 (17.7%) were constitutively resistant (constitutive macrolide-lincosamide-streptogramin B phenotype). The incidence of inducible, constitutive, and MS phenotype was higher in MRSA isolates compared to MS S. aureus (MSSA). The constitutive clindamycin resistance difference between MSSA and MRSA isolates were found to be statistically significant (P = 0.0086).Conclusion:The study revealed 22% of S. aureus isolates were inducible clindamycin resistant, which could be easily misidentified as clindamycin susceptible in Kirby–Bauer disk diffusion method. Therefore, clinical microbiology laboratory should routinely perform D-test in all clinically isolated S. aureus to guide clinicians for the appropriate use of clindamycin.

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“…In fact, cMLS B resistant phenotype was the most common and highest (40%) followed by MS B (37%) and iMLS B (23%) phenotypes. Varying prevalence rates of MLS B resistance phenotype are reported by other studies[15,17,27,28,29]. iMLS B was found higher (44%) in MRSA whereas it was cMLS B (36%) in MSSA.…”

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confidence: 64%

Distribution of Macrolide-Lincosamide-Streptogramin B antibiotics resistance genes in clinical isolates of Staphylococci

Nagarkoti

Prajapati

Sharma³

et al. 2019

Preprint

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Background Staphylococci are the most commonly isolated pathogen from clinical specimen. These isolates are posing threat due to increasing trend of antimicrobial resistance particularly methicillin. Macrolide-lincosamide streptogramin B family of antibiotics is commonly used to treat such infections. This study was aimed to detect the prevalence of inducible clindamycin resistance and observation of erm and msr genes among Staphylococci isolated from tertiary care hospital of Nepal.Methods Staphylococci from different clinical specimen were identified and antibiotic susceptibility profile were determined following Kirby Bauer disc diffusion method. The double disc diffusion or D-zone test as outlined in CLSI document M100-S24 was performed to examine inducible clindamycin resistance isolates. Multiplex PCR was performed for detection of erm and msr gene in isolates using specific primers for ermA , ermB, ermC, msrA and msrB genes.Results Of the 60 Staphylococci isolates, 39 (65%) were Staphylococcus aureus ( S. aureus ) and 21 (35%) were coagulase negative Staphylococci (CNS) with 25 (64%) and 15 (71%) representing methicillin resistant S. aureus and CNS respectively. Constitutive and inducible MLS B phenotype was observed among 24 (40%) and 14 (23%) isolates respectively by D test. The most prevalent resistant gene was ermC gene (37%) followed by msr B (12%), erm B (10%) and msr A (10%). None of the isolates were found to possess erm A gene.Conclusions The resistant genes were detected more among CNS than S. aureus. The presence of constitutive and inducible MLS B as well as resistant genes among Staphylococci necessitates detection of such isolates to minimize treatment failure. The presence of resistant characteristic varies with hospital settings, geographical locations, patients’ demography etc. The result from this study may help elucidate the predominant resistant characteristics in clinical Staphylococci isolated from tertiary care hospital of Nepal.

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Inducible and constitutive clindamycin resistance in Staphylococcus aureus: an experience from Western Nepal

Cited by 16 publications

References 22 publications

Inducible clindamycin and methicillin resistant Staphylococcus aureus in a tertiary care hospital, Kathmandu, Nepal

Inducible clindamycin and methicillin resistant Staphylococcus aureus in a tertiary care hospital, Kathmandu, Nepal

Detection of inducible and constitutive clindamycin resistance among Staphylococcus aureus isolates in a tertiary care hospital, Eastern India

Distribution of Macrolide-Lincosamide-Streptogramin B antibiotics resistance genes in clinical isolates of Staphylococci

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