Inducible clindamycin resistance in clinical isolates of staphylococcus aureus in Suez Canal University Hospital, Ismailia, Egypt

  • Rania Mohammed Kishk Microbiology and immunology department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
  • Maha Mohammed Anani Clinical Pathology department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
  • Nader Attia Nemr Endemic and Infectious diseases department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
  • Nashaat Mohamed Soliman Endemic and Infectious diseases department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
  • Marwa Mohamed Fouad Microbiology and immunology department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Keywords: Clindamycin resistance, inducible, constitutive, MRSA, MLSB, erm genes

Abstract

Introduction: The increasing incidence of methicillin resistance among Staphylococci has led to renewed interest in the usage of macrolide-lincosamide-streptogramin B (MLSB) antibiotics to treat S. aureus infections, with clindamycin being the preferable agent owing to its excellent pharmacokinetic properties. Inducible clindamycin resistance my lead to therapeutic failure.

Aim: Detection of the prevalence of constitutive and inducible clindamycin resistance in clinical isolates of S. aureus to improve the clinical outcomes in patients.

Methodology: A total of 176 non-duplicate staphylococcal isolates were isolated from different clinical samples. Methicillin resistance was detected using Cefoxitin disk diffusion (CDD) method. Phenotypic clindamycin resistance was performed for all isolates by D test. Polymerase Chain Reaction (PCR) assay were done for detection of erm resistance genes (ermA, ermB and ermC).

Results: Out of 176 strains of S. aureus, 108 isolates (61.3%) were identified as MRSA. Erythromycin and clindamycin resistance was detected in 96 isolates (54.5%) and 68 isolates (38.6%) respectively. Clindamycin resistance (cMLSB) was significantly higher (p value < 0.001) in MRSA strains (56 isolates) compared to MSSA (12 isolates). Resistant genes were detected in 160 isolates (91%). The ermA gene was detected in 28 isolates (16%), the ermB gene was detected in 80 isolates (45.5%) (p < 0.001).

Conclusions and recommendations: The frequency of constitutive and inducible clindamycin resistance in MRSA isolates emphasizes the need to use D test in routine antimicrobial susceptibility testing to detect the susceptibility to clindamycin as the inducible resistance phenotype can inhibit the action of clindamycin and affect the treatment efficacy.

Published
2020-11-30
How to Cite
1.
Kishk RM, Anani MM, Nemr NA, Soliman NM, Fouad MM (2020) Inducible clindamycin resistance in clinical isolates of staphylococcus aureus in Suez Canal University Hospital, Ismailia, Egypt. J Infect Dev Ctries 14:1281-1287. doi: 10.3855/jidc.12250
Section
Original Articles