Phenotypic and genotypic evaluation of aminoglycoside resistance in clinical isolates of staphylococci in Tehran, Iran.

Aminoglycosides play an important role in the treatment of staphylococcal infections, despite the emerging widespread resistance among Staphylococcus. To determine the prevalence of aminoglycoside resistance and aminoglycoside modifying enzyme (AME) genes among infected patients at a teaching hospital in Tehran, Iran, we tested 585 Staphylococcus isolates, of which 322 were Staphylococcus aureus and 263 were coagulase-negative staphylococci, as determined by the disk diffusion method and multiplex PCR. The minimum inhibitory concentration of gentamicin for each isolate was determined by microbroth dilution. All methicillin-resistant staphylococci were mecA-positive by PCR. Of the 585 isolates, 27.6% were susceptible to gentamicin and kanamicin, 27.1% to tobramicin and amikacin, and 21.3% to netilmicin. The most prevalent AME genes included aac(6')-Ie-aph(2'') (93.7%) followed by aph(3')-IIIa (84.3%) and ant (4')-Ia (28.1%). More than 90% of aminoglycoside-resistant staphylococci contained at least one AME gene. The coexistence of two or three AME genes was detected in most gentamicin-resistant isolates. These results suggest an alarming rate of aminoglycoside resistance in this test location in Tehran, Iran. Continued surveillance at the genotypic and phenotypic levels, and adherence to well-designed antibiotic and infection-control policies are necessary to limit the spread of antimicrobial resistance.