Should clindamycin be used in treatment of patients with infections caused by erythromycin-resistant staphylococci?

Rao, G. Gopal

doi:10.1093/jac/45.5.715

Cited by 55 publications

(40 citation statements)

References 4 publications

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“…In our study, the inducible CL-R phenotype level was 24.4 % among MRSA isolates, 14.8 % among MSSA isolates, 25.7 % In the light of the restricted range of antibiotics available for the treatment of meticillin-resistant staphylococcal infections and the known limitations of vancomycin, CL should be considered for the management of serious soft tissue infections with meticillin-resistant staphylococci that either are sensitive to CL or exhibit inducible CL-R (Rao, 2000).…”

Section: Discussionmentioning

confidence: 62%

“…CL is a good alternative for the treatment of both meticillin-resistant and -susceptible staphylococcal infections (Fiebelkorn et al, 2003). CL-R can develop in staphylococcal isolates with the inducible phenotype, and spontaneous constitutively resistant mutants have been selected from such isolates both in vitro and in vivo during CL therapy (Drinkovic et al, 2001;Panagea et al, 1999;Siberry et al, 2003 (Rao, 2000).…”

Section: Discussionmentioning

confidence: 99%

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Detection and prevalence of inducible clindamycin resistance in staphylococci

Yılmaz

Aydın

İskender

et al. 2007

Journal of Medical Microbiology

117

104

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Staphylococcus aureus and coagulase-negative staphylococci (CNS) are recognized as causing nosocomial and community-acquired infections in every region of the world. The resistance to antimicrobial agents among staphylococci is an increasing problem. Clindamycin (CL) is considered to be one of the alternative agents in these infections. This study demonstrates a simple, reliable method (double-disc diffusion test) for detecting inducible resistance to CL in erythromycin-resistance (ER-R) isolates of S. aureus and CNS. A total of 883 (52.3 %) isolates of S. aureus and 804 (47.7 %) isolates of CNS were selected from recent (2003)(2004)(2005) clinical isolates recovered in the laboratory of the authors; duplicate isolates were not included. A total of 214 (12.6 %) S. aureus and 308 (18.3 %) CNS isolates were selected based on ER-R and CL sensitivity using standard National Committee for Clinical Laboratory Standards disc diffusion testing. A total of 1687 staphylococcal isolates were included, consisting of 27.5 % meticillin-resistant S. aureus, 24.8 % meticillin-sensitive S. aureus, 36.1 % meticillin-resistant CNS and 11.6 % meticillin-sensitive CNS isolates: 30.9 % of staphylococcal isolates (214 S. aureus and 308 CNS) that were erythromycin resistant and CL sensitive were tested for inducible resistance using the D-test. A D-shaped zone around the CL was observed for 70.9 % of staphylococcal isolates (81.8 % of S. aureus isolates and 63.3 % of CNS isolates) with an ER-R and a clindamycin-sensitive (CL-S) phenotype. The organism was positive for inducible clindamycin resistance (CL-R). There was a 21.9 % level of inducible macrolide-lincosamide-streptogramin B resistance phenotype among all the staphylococcal isolates. When the S. aureus and CNS strains among all the staphylococcal isolates were compared statistically, inducible CL-R in CNS strains was determined to be 23 % more positive (P=0.028, odds ratio 0.77, 95 % confidence interval 0.61-0.98). When a statistical comparison was performed among ER-R but CL-S staphylococcal isolates inducible CL-R in S. aureus strains was determined to be 2.6 times more positive (P=0.000, odds ratio 2.6, 95 % confidence interval 1.68-4.04). A simple, reliable method of detecting inducible resistance to CL in ER-R isolates of S. aureus and CNS is described. Clinical microbiology laboratories should use the double-disc diffusion test as standard practice with all ER-R staphylococci. CL should not be used in patients with infections caused by inducibly resistant staphylococcal isolates. Therapeutic failures may thus be avoided.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Detection and prevalence of inducible clindamycin resistance in staphylococci

Yılmaz

Aydın

İskender

et al. 2007

Journal of Medical Microbiology

117

104

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“…The available data on clinical efficacy of clindamycin therapy in infections with MSLBi strains are limited and present conflicting results [22][23][24][25]. Uncertainty about the reliability of susceptibility reports for clindamycin when D-test results are not available, as well as confusion over the clinical importance of this inducible resistance, has led some clinicians to avoid use of clindamycin for staphylococcal infections whenever erythromycin resistance is noted [7].…”

Section: Discussionmentioning

confidence: 99%

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

Sah¹,

Khanal²,

Lamichhane³

et al. 2015

Int Jour of Biomed Res

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Objective: This study aimed to determine prevalence of inducible and constitutive clindamycin resistance among clinical S. aureus isolates and also study their association with methicillin resistance. Methods: A cross-sectional study including 140 non-duplicate isolates of S. aureus was done. Isolates were identified by standard microbiological methods and methicillin resistance was detected by cefoxitin disc diffusion method. Inducible clindamycin resistance was detected by D-test. Results: Prevalence of inducible and constitutive clindamycin resistance was 12.1% and 7.9% respectively. Constitutive and inducible resistance was associated with MRSA. An unusual phenotype, erythromycin sensitive and clindamycin resistance, was detected in 2 MRSA isolates. Conclusions: Inducible and constitutive clindamycin resistance is comparatively low in our setting. Constitutive and inducible resistance was higher among MRSA than MSSA. However the trends in resistance vary in different places. D-test reporting should be done routinely which will allow clinicians to opt for clindamycin judiciously and avoid potential treatment failure.

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“…By contrast, 16-membered ring macrolides, lincosamides (e.g., clindamycin), and streptogramin B compounds that are not inducers remain active. However, clindamycin therapy for inducible phenotypes can lead to clinical failure of treatment (7,8). The second mechanism is mediated by an efflux pump.…”

Section: Introductionmentioning

confidence: 99%

Macrolide and lincosamide resistance in staphylococcal clinical isolates in Nablus, Palestine

Al-Masri¹,

Hasan²,

Sabbah³

2016

Turk J Med Sci

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Background/aim: Macrolide and lincosamide antibiotics are used for the treatment of staphylococcal infections, especially for penicillin-allergic patients. In the present study, we evaluate the prevalence of resistance to macrolide and lincosamide antibiotics among staphylococci isolates. Materials and methods:A total of 200 staphylococcal clinical isolates were collected from January 2012 to April 2013. Minimal inhibitory concentrations of erythromycin and clindamycin were determined by agar dilution method. An erythromycin-clindamycin induction test was performed for isolates that were only resistant to erythromycin. Representative erythromycin-resistant isolates were examined for erythromycin resistance genes using PCR.Results: Among staphylococci isolates, resistance frequencies of erythromycin and clindamycin were 65.5% and 20.5%, respectively. Erythromycin resistance was found to be mediated by putative efflux (50.4%) and target site modification (49.6%). Inducible target site modification resistance was detected in 19.1% of erythromycin-resistant isolates. Among the examined 36 staphylococci isolates, msr(A), erm(C), erm(A), and mef(A/E) genes were detected in 55.6%, 30.6%, 25%, and 0%, respectively. Conclusion:Results of the current study indicate the presence of high rates of macrolide resistance and inducible phenotypes among staphylococcal isolates. It is also essential to keep in mind variations of resistance rates among various age groups and specimen types.

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Should clindamycin be used in treatment of patients with infections caused by erythromycin-resistant staphylococci?

Cited by 55 publications

References 4 publications

Detection and prevalence of inducible clindamycin resistance in staphylococci

Detection and prevalence of inducible clindamycin resistance in staphylococci

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

Macrolide and lincosamide resistance in staphylococcal clinical isolates in Nablus, Palestine

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