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CC BY-NC-ND 4.0 · Avicenna J Med 2016; 06(03): 75-80
DOI: 10.4103/2231-0770.184066
ORIGINAL ARTICLE

Detection of inducible and constitutive clindamycin resistance among Staphylococcus aureus isolates in a tertiary care hospital, Eastern India

Subasini Majhi
Department of Microbiology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, Utkal University, Bhubaneswar, Odisha, India
,
Muktikesh Dash
Department of Microbiology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, Utkal University, Bhubaneswar, Odisha, India
,
Dharitri Mohapatra
Department of Microbiology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, Utkal University, Bhubaneswar, Odisha, India
,
Ashoka Mohapatra
Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Nirupama Chayani
Department of Microbiology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, Utkal University, Bhubaneswar, Odisha, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Introduction: Clindamycin is an excellent drug for skin and soft tissue Staphylococcus aureus infections, but resistance mediated by inducible macrolide-lincosamide-streptogramin B (iMLS B ) phenotype leads to in vivo therapeutic failure even though they may be in vitro susceptible in Kirby-Bauer disk diffusion method. Objective: The study was aimed to detect the prevalence of iMLS B phenotype among S. aureus isolates by double disk approximation test (D-test) in a tertiary care hospital, Eastern India. Materials and Methods: A total of 209 consecutive S. aureus isolates were identified by conventional methods and subjected to antimicrobial susceptibility testing by Kirby-Bauer disk diffusion method. Erythromycin-resistant isolates were tested for D-test. Results: From 1282 clinical specimens, 209 nonrepeated S. aureus isolates were obtained. Majority of isolates 129 (61.7%) were methicillin-resistant S. aureus (MRSA). There was statistically significant difference between outpatients 60.1% and inpatients 39.9% (P < 0.0001). From 209 S. aureus isolates, 46 (22%) were D-test positive (iMLS B phenotype), 41 (19.6%) were D-test negative (methicillin sensitive [MS] phenotype), and 37 (17.7%) were constitutively resistant (constitutive macrolide-lincosamide-streptogramin B phenotype). The incidence of inducible, constitutive, and MS phenotype was higher in MRSA isolates compared to MS S. aureus (MSSA). The constitutive clindamycin resistance difference between MSSA and MRSA isolates were found to be statistically significant (P = 0.0086). Conclusion: The study revealed 22% of S. aureus isolates were inducible clindamycin resistant, which could be easily misidentified as clindamycin susceptible in Kirby-Bauer disk diffusion method. Therefore, clinical microbiology laboratory should routinely perform D-test in all clinically isolated S. aureus to guide clinicians for the appropriate use of clindamycin.

Keywords

Constitutive macrolide-lincosamide-streptogramin B phenotype - D-test - inducible macrolide-lincosamide-streptogramin B phenotype - methicillin-resistant Staphylococcus aureus - sensitive methicillin phenotype - methicillin-sensitive Staphylococcus aureus - Staphylococcus aureus


Publication History

Article published online:
09 August 2021

© 2016. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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