MACROLIDE-LINCOSAMIDE-STREPTOGRAMIN B RESISTANCE AMONG STAPHYLOCOCCUS AUREUS IN CHITWAN MEDICAL COLLEGE TEACHING HOSPITAL, NEPAL

  • NAVIN KUMAR CHAUDHARY Department of Microbiology, Chitwan Medical College, Bharatpur, Nepal.
  • RUSAN PIYA Department of Laboratory Medicine, Chitwan Medical College, Bharatpur, Nepal.

Abstract

Objectives: Staphylococcus aureus is often linked with human infection. Clindamycin is one of the key substitute antimicrobial agents in the treatment of S. aureus, especially in methicillin-resistant S. aureus (MRSA) infections. Inducible macrolide-lincosamide-streptogramin B (iMLS B) resistance is a crucial factor in antimicrobial susceptibility testing. The intention of the research was to identify S. aureus from distinct clinical specimens and investigate the prevalence of inducible clindamycin resistance among them and also study their association with MRSA.


Methods: A descriptive cross-sectional study was accomplished in the Dept. of Microbiology CMC-TH, Nepal from January 2018 to December 2020 with 525 non-repeated S. aureus obtained from a different clinical specimen. Antibiotic susceptibility test was performed by Kirby–Bauer disc diffusion method. MRSA was detected using cefoxitin (30 μg) and results were interpreted as stated by CLSI. “D-Test” was done by applying erythromycin (15 μg) and clindamycin (2 μg) as per CLSI guidelines. Data were analyzed using SPSS IBM version 20.


Results: Among 525 isolates, there were 315 (60.00%) MRSA. Results of D test analysis showed that 280 (53.33%) were MLSB sensitive while 245 (46.67%) were MLSB resistant; where 80 (15.24%) iMLSB with D zone, 100 (19.05%) constitutive MLSB (cMLSB) phenotype, and 65 (12.38%) MS phenotype. Of a total of 80 iMLSB, a significant proportion of 64 (80.00%) was MRSA (p<0.001). All the isolates were sensitive to vancomycin, teicoplanin, and linezolid. The prevalence of both iMLSB and cMLSB was high among MRSA.


Conclusion: In this study, cMLSB phenotype was predominant (19.05%) followed by iMLSB phenotype (15.25%) and then MS phenotype (12.38%). Inducible iMLS B phenotypes, as well as cMLSB, are higher among MRSA. It is advisable to include “D-Test” as a part of regular antibiotic susceptibility testing to detect iMLSB resistance among S. aureus.

Keywords: Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus, Clindamycin resistance, Erythromycin resistance, D-Test, Inducible macrolide-lincosamide-streptogramin B, Constitutive MLSB, MS phenotype

References

1. Licitra G. Etymologia Staphylococcus. Emerg Infect Dis 2013;19:1553.
2. Taylor TA, Unakal CG. Staphylococcus aureus. Treasure Island, FL: StatPearls Publishing; 2021.
3. Patel P, Khandelwal N, Raval P, Patel B, Soni S, Vegad M. Prevalence and antimicrobial susceptibility pattern of methiciliin resistant Staphylococcus aureus in tertiary care teaching hospital-Western India. Int J Med Sci Public Health 2014;3:58-60.
4. Forbes BA, Sahm DF, Weissfeld AS, Bailey WR. Bailey and Scott’s Diagnostic Microbiology. 12th ed. St Louis: Elsevier Mosby; 2007. p. 254-64.
5. Chambers HF. The changing epidemiology of Staphylococcus aureus? Emerg Infect Dis 2001;7:178-82.
6. Kluytmans J, Belkum AV, Verbrugh H. Nasal carriage of Staphylococcus aureus: Epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505-20.
7. Fokas S, Fokas S, Tsironi M, Kalkani M, Dionysopouloy M. Prevalence of inducible clindamycin resistance in macrolide-resistant Staphylococcus spp. Clin Microbiol Infect 2005;11:337-40.
8. Sasirekha B. Prevalence of ESBL, AmpC ?-lactamases and MRSA among uropathogens and its antibiogram. EXCLI J 2013;12:81-8.
9. Mama M, Aklilu A, Misgna K, Tadesse M, Alemayehu E. Methicillin and inducible clindamycin resistant Staphylococcus aureus among patients with wound infection attending Arba Minch hospital, South Ethiopia. Hindawi Int J Micro 2019;2965490:1-9.
10. Delialioglu N, Aslan G, Ozturk C, Baki V, Sen S, Emekdas G. Inducible clindamycin resistance in staphylococci isolated from clinical samples. Jpn J Infect Dis 2005;58:104-6.
11. Blair JM, Webber MA, Baylay AJ, Ogbolu DO, Piddock LJ. Molecular mechanisms of antibiotic resistance. Nat Rev Microbiol 2015;13:42-51.
12. Jindal N, Singh S, Grover P, Malhotra R. Prevalence of inducible clindamycin resistance among clinical isolates of MRSA in Malwa region of Punjab (North India). Indian J Res 2013;2:133-4.
13. Wayne P. Clinical and Laboratory Standards Institute: Performance Standards for Antimicrobial Susceptibility Testing. 20th Informational Supplement. CLSI Document M100-S20. Wayne, PA: Clinical and Laboratory Standards Institute; 2010.
14. Maltezou HC, Giamarellou H. Community-acquired methicillin-resistant Staphylococcus aureus infections. Int J Antimicrob Agents 2006;27:87-96.
15. Drinkovic D, Fuller ER, Shore KP, Holland DJ, Ellis-Pegler R. Clindamycin treatment of Staphylococcus aureus expressing inducible clindamycin resistance. J Antimicrob Chemother 2001;48:315-6.
16. Schreckenberger PC, Ilendo E, Ristow KL. Incidence of constitutive and inducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci in a community and a tertiary care hospital. J Clin Microbiol 2004;42:2777-9.
17. Sah P, Khanal R, Lamichhane P, Upadhaya S, Lamsal A, Pahwa V. Inducible and constitutive clindamycin resistance in Staphylococcus aureus: An experience from Western Nepal. Int J Biomed Res 2015;6:316-9.
18. Amatya R, Shrestha R. Incidence of macrolide lincosamide streptogramin B resistance in coagulase negative staphylococci from a tertiary care hospital in Nepal. Nepal Med Coll J 2015;17:157-60.
19. Wayne P. Clinical and Laboratory Standards Institute: Methods for Dilution Antimicrobial Susceptibility Test for Bacteria that Grow Aerobically; Approved Standard. 10th ed. CLSI Document M07-A10. Wayne, PA: Clinical and Laboratory Standards Institute; 2015.
20. Wayne P. Clinical and Laboratory Standards Institute: Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard. 12th ed. CLSI Document M02-A12. Wayne, PA: Clinical and Laboratory Standards Institute; 2015.
21. Smolinski MS, Hamburg MA, Lederberg J. Microbial Threats to Health: Emergence, Detection and Response. Washington, DC: National Academies Press; 2003.
22. Waldvogel FA. Mandell, Douglas, Bennett’s Principle and Practice of Infectious Diseases. 5th ed. Philadelphia, PA: Churchill Livingstone; 2000.
23. Yilmaz G, Aydin K, Iskender S, Caylan R, Koksal I. Detection and prevalence of inducible clindamycin resistance in staphylococci. J Med Microbiol 2007;56:342-5.
24. Perez LR, Caierao J, Antunes AL, d’Azevedo PA. Use of the D test method to detect inducible clindamycin resistance in coagulase negative staphylococci (CoNS). Braz J Infect Dis 2007;11:186-8.
25. Singh GK, Chaudhari BK, Parajuli KP. Phenotypic study of macrolide-lincosamide-streptogramin B resistance in Staphylococcus aureus and their relationship with methicillin-resistant Staphylococcus aureus (MRSA) at tertiary care in Eastern Nepal. J Nob Med Coll 2016;5:1-5.
26. Ansari S, Nepal HP, Gautam R, Rayamajhi N, Shrestha S, Upadhyay G, et al. Threat of drug resistant Staphylococcus aureus to health in Nepal. BMC Infect Dis 2014;14:157.
27. Parasa LS, Tumati SR, Chigurupati SP, Parabathina RK, Santhisree K, Kumar LC, et al. Prevalence of induced clindamycin resistance in methicillin resistant Staphylococcus aureus from hospital population of coastal Andhara Pradesh, South India. Arch Clin Microbiol 2011;2:1-6.
28. Van der Heijden I, Sinto S, Oplustil S, Mendes C, editors. Occurrence of MLS Resistance in Staphylococcal and Streptococcol Clinical Isolates. Washington DC: Abstract A-86. 101st General Meeting of the American Society for Microbiology; 2001.
29. Mohapatra T, Shrestha B, Pokhrel BM. Constitutive and inducible clindamycin resistance in Staphylococcus aureus and their association with meticillin-resistant S. aureus (MRSA): Experience from a tertiary care hospital in Nepal. Int J Antimicrob Agents 2009;33:187-9.
30. Raut S, Bajracharya K, Adhikari J, Pant SS, Adhikari B. Prevalence of methicillin resistant Staphylococcus aureus in Lumbini Medical College and Teaching Hospital, Palpa, Western Nepal. BMC Res Notes 2017;10:187.
31. Shrestha B, Pokhrel BM, Mohapatra TM. Phenotypic characterization of nosocomial isolates of Staphylococcus aureus with reference to MRSA. J Infect Dev Ctries 2009;3:554-60.
32. Lall M, Sahni A. Prevalence of inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Med J Armed forces India 2014;70:43-7.
33. Schmitz FJ, Petridou J, Fluit A, Hadding U, Peters G, Von Eiff C, et al. Distribution of macrolide-resistance genes in Staphylococcus aureus blood-culture isolates from fifteen German university hospitals. Eur J Clin Microbiol Infect Dis 2000;19:385-7.
34. Sanchez ML, Flint KK, Jones RN. Occurrence of macrolide-lincosamide-streptogramin resistances among staphylococcal clinical isolates at a university medical center: Is false susceptibility to new macrolides and clindamycin a contemporary clinical and in vitro testing problem? Diagn Microbiol Infect Dis 1993;16:205-13.
35. Levin TP, Suh B, Axelrod P, Truant AL, Fekete T. Potential clindamycin resistance in clindamycin-susceptible, erythromycin-resistant Staphylococcus aureus: Report of a clinical failure. Antimicrob Agents Chemother 2005;49:1222-4.
36. Marr JK, Lim AT, Yamamoto L. Erythromycin-induced resistance to clindamycin in Staphylococcus aureus. Hawaii Med J 2005; 64:6-8.
37. Pandey S, Raza M, Bhatta C. Prevalence and antibiotic sensitivity pattern of methicillin-resistant-Staphylococcus aureus in Kathmandu medical college teaching hospital. J Inst Med 2013;34:13-7.
38. Thapa S, Sapkota LB. Prevalence of inducible clindamycin resistance in erythromycin resistant clinical isolates of Staphylococcus aureus and CONS at tertiary care hospital. JCMS Nepal 2016;12:83-8.
39. Sanjana R, Shah R, Chaudhary N, Singh Y. Prevalence and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) in CMS-teaching hospital: A preliminary report. JCMS Nepal 2010;6:1-6.
40. Baral R, Khanal B, Acharya A. Antimicrobial susceptibility patterns of clinical isolates of Staphylococcus aureus in Eastern Nepal. Health Renaissance 2011;9:78-82.
41. Mishra SK, Rijal BP, Pokhrel BM. Emerging threat of multidrug resistant bugs-Acinetobacter calcoaceticus baumannii complex and methicillin resistant Staphylococcus aureus. BMC Res Notes 2013;6:98.
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CHAUDHARY, N. K., and R. PIYA. “MACROLIDE-LINCOSAMIDE-STREPTOGRAMIN B RESISTANCE AMONG STAPHYLOCOCCUS AUREUS IN CHITWAN MEDICAL COLLEGE TEACHING HOSPITAL, NEPAL”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 14, no. 5, May 2021, pp. 61-65, doi:10.22159/ajpcr.2021.v14i5.41012.
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