Rania Mohammed Kishk1, Maha Mohammed Anani2, Nader Attia Nemr3, Nashaat Mohamed Soliman4, Marwa Mohamed Fouad5. 1. Microbiology and immunology department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. raniakishk@med.suez.edu.eg. 2. Clinical Pathology department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. mahaenany77@gmail.com. 3. Endemic and Infectious diseases department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. nadernemr@med.suez.edu.eg. 4. Endemic and Infectious diseases department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. nhawass@yahoo.com. 5. Microbiology and immunology department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. marwafouad80@gmail.com.
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. Copyright (c) 2020 Rania Mohammed Kishk, Maha Mohammed Anani, Nader Attia Nemr, Nashaat Mohamed Soliman, Marwa Mohamed Fouad.
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. Copyright (c) 2020 Rania Mohammed Kishk, Maha Mohammed Anani, Nader Attia Nemr, Nashaat Mohamed Soliman, Marwa Mohamed Fouad.