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Inducible clindamycin resistance among clinical isolates of staphylococci  [cached]
Ciraj A,Vinod P,Sreejith G,Rajani K
Indian Journal of Pathology and Microbiology , 2009,
Abstract: Introduction: Clinical failure of clindamycin therapy has been reported due to multiple mechanisms that confer resistance to macrolide, lincosamide and streptogramin antibiotics. This study was undertaken to detect the presence of inducible clindamycin resistance among clinical isolates of staphylococci. Materials and Methods: The detection of inducible clindamycin resistance was performed by D-test using erythromycin and clindamycin discs as per CDC guidelines. Results: Among the 244 clinical isolates of staphylococci studied, 32 (13.1%) showed inducible clindamycin resistance and belonged to the MLSBi phenotype. Among the MLS B i phenotypes, 10 isolates were methicillin-resistant Staphylococcus aureus (38.4% of the total MRSA), 16 were methicillin-sensitive Staphylococcus aureus (12.9% of the total MSSA) and 6 were coagulase-negative staphylococci (6.3% of the total CONS). Conclusion: The test for inducible resistance to clindamycin should be included in the routine antibiotic susceptibility testing, as it will help in guiding therapy.
Detection of inducible clindamycin resistance among clinical isolates of staphylococci from a rural tertiary care hospital
Makam Sri Rangakumar Manjunath, Vijaya Rayapu, Dhandapany Senthil Pragash, Ivvala Anand Shaker, Sandeep Kasukurthy
International Journal of Medical Research and Health Sciences , 2013, DOI: 10.5958/j.2319-5886.2.2.026
Abstract: Clindamycin has been used successfully to treat pneumonia and soft tissue infections caused by methicillin-resistant Staphylococcus aureus. However, Clinical failure of clindamycin therapy has been reported due to multiple mechanisms that confer resistance to Macrolide, Lincosamine and Streptogramin antibiotics. A total of 96 staphylococcal isolates from different clinical specimens were tested for inducible clindamycin resistance by the disk-diffusion induction test. Inducible clindamycin resistance was detected in 47.22% of methicillin-resistant Staphylococcus aureus isolates and in 21.67% of methicillin-sensitive Staphylococcus aureus isolates. In our setting, clindamycin is safe and effective agent to treat both systemic sand localized Staphylococcal infections, but we recommend that staphylococci isolates, particularly methicillin-resistant Staphylococcus aureus
Inducible Clindamycin Resistance among Staphylococci Isolated from Burn Patients
A Zorgani, O Shawerf, K Tawil, E El-Turki, KS Ghenghesh
Libyan Journal of Medicine , 2009,
Abstract: Clindamycin has been used successfully to treat pneumonia and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. However, inducible clindamycin resistance has been described as a cause of treatment failure of such infections. A total of 159 staphylococcal isolates from different clinical specimens from burn patients in Tripoli Burn Center were tested for inducible clindamycin resistance by the disk-diffusion induction test. Inducible clindamycin resistance was detected in 66.2% of 65 methicillin-resistant S. aureus isolates and in none of 55 methicillin-sensitive S. aureus, 10 methicillin-resistant coagulase negative staphylococci and 29 methicllin-sensitive coagulase negative staphylococci isolates. In our setting, clindamycin can be used for the treatment of infections due to staphylococci, but we recommend that staphylococci isolates, particularly methicillin-resistant S. aureus, are tested by the D-test before treatment.
Inducible clindamycin resistance in Staphylococcus aureus: A study from North India  [cached]
Gupta V,Datta P,Rani H,Chander J
Journal of Postgraduate Medicine , 2009,
Abstract: Background : The resistance to antimicrobial agents among Staphylococci is an increasing problem. The resistance to macrolide can be mediated by msr A gene coding for efflux mechanism or via erm gene encoding for enzymes that confer inducible or constitutive resistance to macrolide, lincosamide and Type B streptogramin. Aim : The present study was aimed to find out the percentage of Staphylococcus aureus having inducible clindamycin resistance (iMLS B ) in our geographic area using D-test. Also, we tried to ascertain the relationship between Methicillin-resistant Staphylococcus aureus (MRSA) and inducible clindamycin resistance, association of these iMLS B isolates with community or nosocomial setting and treatment options for these iMLS B isolates. Settings and Design : A total of 200 non-duplicate Staphylococcus aureus isolates from various clinical samples from both outdoor and indoor patients were studied. Materials and Methods : Susceptibility to routine antimicrobial agents was carried out using Kirby Bauer method. Methicillin resistance was detected by oxacillin disc on Mueller Hinton agar (MHA) supplemented with 2% NaCl. D-test was performed on all erythromycin-resistant and clindamycin-sensitive Staphylococcus aureus strains to detect inducible clindamycin resistance. Results : Among 200 Staphylococcus aureus strains, 50 (25%) were found to be MRSA and 36 were D-test positive. Also, MRSA isolates showed both higher inducible resistance and constitutive resistance to clindamycin as compared to Methicillin-sensitive Staphylococcus aureus (MSSA). Out of 36 isolates of Staphylococcus aureus showing inducible clindamycin resistance, 24 were from the outpatient department and 12 were recovered from indoor patients. All isolates of Staphylococcus aureus showed 100% sensitivity to vancomycin and linezolid. Conclusions : Clindamycin is kept as a reserve drug and is usually advocated in severe MRSA infections depending upon the antimicrobial susceptibility results. We have reported a higher incidence of iMLS B from both community (66.67%) as well as hospital (33.33%) setup. Therefore clinical microbiology laboratory should report inducible clindamycin resistance routinely.
Use of the D test method to detect inducible clindamycin resistance in coagulase negative staphylococci (CoNS)
Perez, Leandro Reus Rodrigues;Caier?o, Juliana;Antunes, Ana Lúcia Souza;d'Azevedo, Pedro Alves;
Brazilian Journal of Infectious Diseases , 2007, DOI: 10.1590/S1413-86702007000200002
Abstract: according to the national committee for clinical laboratory standards (nccls, 2004), a method to evaluate the inducible clindamycin resistance in accordance with an approach of the disks of erythromycin and clindamycin - the d test - has been reported. we analyzed the performance of this method in 200 coagulase negative staphylococci (cons) strains obtained from blood cultures of hospitalized patients at a general hospital in southern brazil. twenty-seven clinical isolates with suitable profile (erythromycin-resistant and clindamycin-susceptible) were evaluated for the d test realization. thus, only 5 cons were d test positive. the d test method showed to be simple and an important technique in the detection of inducible clindamycin resistance.
Incidence of Constitutive and Inducible Clindamycin Resistance in Clinical Isolates of Methicillin Resistant Staphylococcus aureus  [cached]
Monthon LERTCANAWANICHAKUL,Kittisak CHAWAWISIT,Apinya CHOOPAN,Krisanawan NAKBUD
Walailak Journal of Science and Technology , 2007, DOI: 10.2004/vol4iss2pp155-163
Abstract: Without the double-disk test, all the Staphylococcus aureus isolates with inducible clindamycin resistance would have been misclassified as clindamycin susceptible, resulting in an underestimated clindamycin resistance rate. Clindamycin resistance rates may vary by geographic region and methicillin susceptibility. Hence it should be determined in individual settings. The high frequency of methicillin resistant S. aureus (MRSA) and methicillin susceptible S. aureus (MSSA) isolates with in vitro inducible clindamycin resistance at hospitals raises concern that clindamycin treatment failures may occur with MSSA as well as with MRSA infections. Clinical laboratories should report in vitro inducible clindamycin resistance in S. aureus isolates and clinicians should be aware of the potential of clindamycin treatment failure in patients with infections caused by inducible resistant strains. In this study, the percentage of inducible clindamycin resistance at two hospitals (Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat, Thailand and Chumphon Khet Udomsak Hospital, Chumphon, Thailand) were 50 (25/50) and 8.3 (1/12) for methicillin resistant Staphylococcus aureus, respectively. Given the data of inducible resistance to clindamycin found in the two hospitals, we conclude that susceptibility testing of staphylococci should include the disk diffusion induction test (D-test) for usefulness of therapeutic treatment of staphylococci infections.
Detection of inducible clindamycin resistance among Staphylococcal isolates from different clinical specimens in western India  [cached]
Pal N,Sharma B,Sharma R,Vyas L
Journal of Postgraduate Medicine , 2010,
Abstract: Background: Macrolide (MLS B ) resistance is the most widespread and clinically important mechanism of resistance encountered with Gram-positive organisms. Resistance may be constitutive (cMLS B phenotype) or inducible (iMLS B phenotype). The iMLS B phenotypes are not differentiated by using standard susceptibility test methods, but can be distinguished by erythromycin-clindamycin disk approximation test (D-test) and demonstration of resistance genes by molecular methods. Aims: To demonstrate in vitro inducible clindamycin resistance (iMLS B ) in erythromycin-resistant (ER) and clindamycin-susceptible (CLI-S) clinical isolates of Staphylococci spp., and interpretation of susceptibility tests to guide therapy. Materials and Methods: Eight hundred and fifty-one isolates of Staphylococci spp. were recovered from various clinical specimens. All the Staphylococcal spp. were identified by conventional microbiological methods including colony morphology, Gram stain, catalase, slide coagulase and tube coagulase. Antibiotic susceptibility testing was performed by Kirby Bauer disc diffusion method. Erythromycin-resistant isolates were examined for inducible clindamycin resistance (iMLS B ) by using double disk approximation test (D-test) at 15 mm disk separation. Results: The Staphylococci spp. isolated were 379 S. aureus [31.60% methicillin-resistant S. aureus (MRSA), 12.92% methicillin-sensitive S. aureus (MSSA)] and 472 coagulase-negative Staphylococci (CNS) [37.60% methicillin-resistant coagulase-negative Staphylococci (MRCNS), 17.86% methicillin-sensitive coagulase-negative Staphylococci (MSCNS)]. Four hundred and thirty (50.52%) Staphylococcal spp. isolates showed erythromycin resistance. Constitutive resistance was demonstrated in 202 (46.97%), inducible clindamycin resistance (iMLS B ) in 101 (23.48%), and non-inducible (MS) in 127 (29.53%). Two distinct induction phenotypes, D (18.13%) and D + (5.34%) were observed. All iMLS B isolates were susceptible to linezolid and vancomycin while 78.78% to ciprofloxacin. Conclusions: Fifty percent of Staphylococcal spp. were ER among which 23.48% were iMLS B phenotypes. Eighty-seven per cent of iMLS B phenotypes were observed to be methicillin-resistant. The high frequency of methicillin resistance isolates (87.12%) with in vitro inducible clindamycin resistance at our institute raises concern of clindamycin treatment failures with methicillin-resistant infections. So we recommend that microbiology laboratories should include the D-test for inducible resistance to clindamycin in the routine antibiotic susceptibilit
Inducible Clindamycin Resistance in Staphylococcus aureus: A Cross-Sectional Report  [PDF]
Mohammad Rahbar,Masoud Hajia
Pakistan Journal of Biological Sciences , 2007,
Abstract: The incidence of inducible clindamycin resistance were studied in Milad Hospital of Tehran, Iran. Of 175 isolates of S. aureus 17(9.7%) isolates showed inducible clindamycin resistance. Of 17 inducible clindamycin isolates of S. aureus, 11 strains were methicillin resistant S. aureus (MRSA) and 6 isolates were methicillin susceptible S. aureus) (MSSA). All isolates were susceptible to vancomycin and linozolide. We conclude that it is necessary to perform D-test for detection of inducible clindamycin in staphylococci in routine laboratory practices.
Inducible clindamycin resistance in Staphylococcus aureus isolates recovered from Mashhad, Iran  [cached]
Najmeh seifi,Nadia kahani,Emran askari,Somayeh mahdipour
Iranian Journal of Microbiology , 2012,
Abstract: Background and Objectives: Staphylococcus aureus is an important agent in hospital and community-associated infections, causing high morbidity and mortality. Introduction of the new antimicrobial classes for this pathogen is usually followed by the emergence of resistant strains through multiple mechanisms. For instance, resistance to clindamycin (CLI), can be constitutive or inducible. Inducible clindamycin resistance which may lead to treatment failure can simply be identified by performing D-test. The aim of this study was to determine the prevalence of inducible clindamycin resistance among Staphylococcus aureus isolates by D-test method.Materials and Methods: This was a cross-sectional study conducted on 254 non-duplicated S. aureus isolates in Imam Reza hospital of Mashhad during 2010. Susceptibility to oxacillin, cefoxitin, erythromycin and clindamycin was performed by disk agar diffusion method according to CLSI guidelines and D-shaped clindamycin susceptibility patterns where considered as D-test positive (D+).Results: Of 211 S. aureus isolates 88 (37.82%) were methicillin resistant. It was found that of 88 MRSA isolates, 78 (88.63%) were erythromycin (ERY) resistant and 46 (52.27%) were CLI resistant. ERY and CLI resistance in MSSA strains was 21.95% and 11.96% respectively. Inducible clindamycin resistance was detected in 18 (20.45%) MRSA isolates. 47(53.40%) of MRSA isolates and 9 (7.32%) of MSSA showed constitutive MLSB phenotype.Conclusion: In conclusion, we found a high prevalence of inducible clindamycin resistance phenotype in our region. We recommend that whenever clindamycin is intended for S. aureus infections, D-test should be performed to facilitate the optimal treatment of patients.Keywords: Staphylococcus aureus, clindamycin, Inducible resistance
Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples  [cached]
Deotale V,Mendiratta D,Raut U,Narang P
Indian Journal of Medical Microbiology , 2010,
Abstract: Purpose: Clindamycin is commonly used in the treatment of erythromycin resistant Staphylococcus aureus causing skin and soft tissue infections. In vitro routine tests for clindamycin susceptibility may fail to detect inducible clindamycin resistance due to erm genes resulting in treatment failure, thus necessitating the need to detect such resistance by a simple D test on routine basis. Materials and Method: 247 Staphylococcus aureus isolates were subjected to routine antibiotic susceptibility testing including oxacillin (1ìg) by Kirby Bauer disc diffusion method. Inducible clindamycin resistance was detected by D test, as per CLSI guidelines on erythromycin resistant isolates. Results: 36 (14.5%) isolates showed inducible clindamycin resistance, nine (3.6%) showed constitutive resistance while remaining 35 (14.1%) showed MS phenotype. Inducible resistance and MS phenotype were found to be higher in MRSA as compared to MSSA (27.6%, 24.3% and 1.6%, 4% respectively). Conclusion: Study showed that D test should be used as a mandatory method in routine disc diffusion testing to detect inducible clindamycin resistance.
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