Influence of Disk Separation Distance on Accuracy of the Disk Approximation Test for Detection of Inducible Clindamycin Resistance in<i>Staphylococcus</i>spp

O’Sullivan, Matthew; Cai, Yongwei; Kong, Fanrong; Zeng, Xianyu; Gilbert, Gwendolyn L.

doi:10.1128/jcm.01632-06

Cited by 46 publications

(39 citation statements)

References 33 publications

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“…In the Netherlands, the MRSA prevalence is still low, but is increasing. 10 The higher percentage of S. aureus with a MRSA-related genetic background might result in a higher MRSA carriage rate among GPs, and in transmission of MRSA from GPs to patients.…”

Section: Implications For Future Research and Clinical Practicementioning

confidence: 99%

Staphylococcus aureuscarriage among GPs in the Netherlands

Rijnders

Nys²,

Driessen³

et al. 2010

Br J Gen Pract

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Observational, point-prevalence, and cross-sectional study. SettingGPs attending the annual conference of the Dutch College of General Practitioners in 2006. MethodNasal swabs were randomly taken from 395 GPs and analysed for the presence of S. aureus. Antimicrobial susceptibility was determined by a microbroth dilution method and the genotypes by spa typing, which was associated with multilocus sequence typing. ResultsOf the GPs, 129/395 (33%; 95% confidence interval [CI] = 28 to 37%) were carriers of S. aureus. No meticillin-resistant S. aureus (MRSA) was found. Resistance was observed to penicillin (71%; 95% CI = 63 to 79%), fusidic acid (7%; 95% CI = 3 to 13%), and clarithromycin (6%; 95% CI = 3 to 12%). In 72% of the isolates, an MRSA-related genotype of S. aureus was found. ConclusionThe low antibiotic resistance found among S. aureus of GPs suggests that GPs are not a reservoir of antibioticresistant S. aureus strains. The relatively high resistance to fusidic acid, which has not previously been described in the Netherlands and is mostly because of antibiotic use, suggests that patients infect GPs and not the other way round. GPs may be at risk for nasal carriage of S. aureus with an MRSA-related genotype.

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Section: Implications For Future Research and Clinical Practicementioning

confidence: 99%

Staphylococcus aureuscarriage among GPs in the Netherlands

Rijnders

Nys²,

Driessen³

et al. 2010

Br J Gen Pract

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“…It results in resistance to macrolides and streptogramin B antibiotics, but not to lincosamides (MS phenotype). Clindamycin is active against such isolates and there is no risk of therapy failure in such cases [9].…”

Section: Introductionmentioning

confidence: 99%

“…Macrolide resistance due to ribosomal target modification affects the activities of both macrolides and clindamycin; it is mediated by erythromycin ribosomal methylases encoded by ermA/ermC genes. Such resistance may be inducible or constitutive [8,9]. Macrolide resistance due to active efflux is encoded by the macrolide-streptogramin resistance (msrA) gene in Staphylococcus spp.…”

Section: Introductionmentioning

confidence: 99%

Inducible and constitutive clindamycin resistance in Staphylococcus aureus in a northeastern Indian tertiary care hospital

Banik

Khyriem

Gurung

et al. 2015

J Infect Dev Ctries

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Introduction: Staphylococcus aureus is one of the most common pyogenic bacteria. They are notorious for developing prompt resistance to newer antimicrobials. With increasing incidence of methicillin-resistant S. aureus (MRSA) isolates, the treatment options are also becoming limited. Clindamycin is an excellent drug for skin and soft tissue infections, but resistance mediated by the inducible phenotype (iMLS B ) leads to in vivo therapeutic failure even though there may be in vitro susceptibility. The double disk approximation test (D-test) can reliably detect the presence of such isolates. This study was aimed to detect and report the prevalence of the iMLS B phenotype in NEIGRIHMS, a tertiary care center in Northeast India. Methodology: A total of 243 consecutive isolates were subjected to routine identification tests followed by antimicrobial sensitivity testing.Erythromycin-resistant isolates were tested for inducible resistance phenotype by the D-test. Results: Among strains tested, 95 (39%) were erythromycin resistant. Twenty-six (10.7%) isolates were D-test positive (iMLS B phenotype), 41 (16.88%) were constitutively resistant (cMLS B phenotype), and 28 isolates (11.52%) were found to be negative by D-test. The incidence of both inducible and constitutive phenotypes was higher in MRSA isolates compared to methicillin-sensitive S. aureus (MSSA) isolates. Conclusions: This study revealed a moderate prevalence of the inducible clindamycin phenotype in the staphylococcal isolates tested. Clinical microbiology laboratories in areas of high MRSA prevalence should consider performing the D-test routinely. This will help prevent prescription of drug(s) whose therapeutic efficacy is doubtful.

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“…We can only speculate that the difference between our results and those of Fiebelkorn and colleagues is caused by the difference in the genes that encode the inducible resistance. It has been shown that isolates with erm(A) show more false-negative D-test results than isolates with erm(C) (O'Sullivan et al, 2006). The difference in the genes encoding inducible resistance to clindamycin might also explain why there are more false-negative D-tests for S. aureus isolates in tests where disks are placed at a distance of 25 mm, while for CNS isolates the number of falsenegative isolates at this distance is low.…”

Section: Discussionmentioning

confidence: 89%

D-Zone test for detection of inducible clindamycin resistance using SirScan paper disks and Rosco Neo-Sensitabs at 25 and 15 mm distances

Yusuf

Bel

Bouasse

et al. 2014

Journal of Medical Microbiology

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Clindamycin is a possible antibiotic treatment of infections by Gram-positive cocci. However, its use can be limited by inducible clindamycin resistance. To screen for the presence of this type of resistance, the D-zone test is used. The aim of this study was to compare the performance of SirScan paper disks with that of Rosco Neo-Sensitabs for the D-zone test at distances according to dispensers provided by the manufacturers (25 mm) and when the disks are placed at a distance of 15 mm. We studied 364 Gram-stain-positive cocci representing clinical isolates that were resistant to erythromycin and susceptible to clindamycin. Out of these isolates, 207 (57 %) gave a positive D-zone test result at 25 mm distance using SirScan paper disks. When the test was repeated with the same disks placed 15 mm from the 157 (43 %) isolates that had previously given a negative result, 58 (36.9 %) gave a positive D-zone test result. The same isolates were also found to test positive when Rosco Neo-Sensitabs were used. Placing the disks at a distance of 15 mm instead of 25 mm led to an 84.3 % increase in positive D-tests among Staphylococcus aureus, 43.8 % among group B streptococci (GBS) and 6.4 % among coagulase-negative staphylococci (CNS). In conclusion, the SirScan paper disks are equivalent to Rosco NeoSensitabs in screening for inducible resistance to clindamycin. The D-test needs to be performed at a shorter distance (15 mm) to prevent false-negative reporting.

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Influence of Disk Separation Distance on Accuracy of the Disk Approximation Test for Detection of Inducible Clindamycin Resistance inStaphylococcusspp

Cited by 46 publications

References 33 publications

Staphylococcus aureuscarriage among GPs in the Netherlands

Staphylococcus aureuscarriage among GPs in the Netherlands

Inducible and constitutive clindamycin resistance in Staphylococcus aureus in a northeastern Indian tertiary care hospital

D-Zone test for detection of inducible clindamycin resistance using SirScan paper disks and Rosco Neo-Sensitabs at 25 and 15 mm distances

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