American Journal of Clinical and Experimental Medicine

| Peer-Reviewed |

Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria

Received: 20 March 2016    Accepted: 30 March 2016    Published: 11 May 2016
Views:       Downloads:

Share This Article

Abstract

Clindamycin is indicated in the treatment of skin and soft-tissue infections caused by Staphylococcal species. Treatment of an infection caused by a strain carrying inducible erm gene using clindamycin or any non-inducer macrolide can lead to clinical failure. The present study was aimed to detect inducible-clindamycin resistance (MLSBi) among S. aureus isolates in Port Harcourt, Nigeriaand to study the relationship between clindamycin and methicillin-resistant (MRSA).Two hundred and five (205) non-duplicate Staphylococcus aureus previously isolated from human sources were randomly collected from three health facilities- University of Port Harcourt Teaching Hospital, Braithwaite Memorial Specialist Hospital and De-Integrated Laboratories-all located in Port Harcourt, Nigeria, for this study from August, 2012 to July, 2013. Isolates were grouped as hospital in-patient (termed hospital- acquired – Nosocomial; n = 76) and out- patient cases (community-acquired; n = 129) Staphylococcus aureus . The isolates collected were reconfirmed following standard laboratory protocols. All confirmed isolates were stored in glycerol at +4°C (later sub-cultured for various phenotypic analyses). Using the disk diffusion method, detection of MRSA was carried out with 1μg of oxacillin (OXOID) placed on Mueller-Hinton agar with 4% NaCl supplementation).Antimicrobial susceptibility testing was performed using Erythromycin (15μg) and Clindamycin (2μg) both obtained from OXOID, UK. All clindamycin-sensitive isolates that were also erythromycin-resistant were subjected to D-Test phenotype (Inducible-clindamycin resistance). Among the 205 S. aureus isolates studied, Forty-four (21.5%) showed resistance to erythromycin, while 38 of these erythromycin-resistant isolates were simultaneously sensitive to clindamycin. Overall, out of 205 isolates, inducible-clindamycin resistance was detected in 23 (11.2%) of the isolates. These 23 (inducible MLSB phenotype) are among 38 erythromycin-resistant S. aureus that were simultaneously sensitive (phenotypically) to clindamycin. Ten (4.9%) of the total (205) study isolates expressed constitutive resistance to clindamycin. Oxacillin Resistance (MRSA) was detected in 25 (12.2%) of the 205 isolates. Among the 38 erythromycin-resistant S. aureus, four were MRSA while 3 (75%) of the 4 erythromycin-resistant MRSA expressed inducible resistance to clindamycin. 20 (58.8%) of 34 erythromycin-resistant MSSA expressed inducible resistance to clindamycin. MRSA phenotype was not significantly correlated (p=0.9430) to inducible-clindamycin resistance. Inducible clindamycin-resistance often leads to treatment failure. The clinical microbiology laboratories in Nigeria should consider routine testing and reporting of inducible clindamycin resistance in S. aureus . There is also the need for sustained surveillance of antimicrobial susceptibilities of S. aureus in this region.

DOI 10.11648/j.ajcem.20160403.13
Published in American Journal of Clinical and Experimental Medicine (Volume 4, Issue 3, May 2016)
Page(s) 50-55
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Staphylococcus aureus , MRSA, Erythromycin- Resistance, Inducible-Clindamycin Resistance

References
[1] Shittu, A. O., Lin, J. and Kolawole, D. O. (2006). Antimicrobial susceptibility patterns of Staphylococcus aureus and characterization of MRSA in Southwestern Nigeria. Wounds, 18, 77-84.
[2] Shittu, A., Oyedara, O., Abegunrin, F. Okon, K. Raji, A. Taiwo, S. Ogunsola, F., Onyedibe, K. and Elisha, G. (2012). Characterization of methicillin-susceptible and -resistant staphylococci in the clinical setting: a multicentre study in Nigeria. Biomed Central Infectious Diseases, 12, 286-295.
[3] Nwokah, E. G. Obunge, O. K, Ayodele, M. B. O., Abbey, S. D. and Tatfeng, Y. M. (2012). Nasal Carriage of Staphylococcus aureus and MRSA among Food Handlers in a Sub-Urban Setting in Rivers State, Nigeria. Nigerian Biomedical Science Journal, 8 (3), 58-61.
[4] Okwu, M. U., Okorie, T. G., Mitsan, O. and Osakue, E. O. (2014). Prevalence and comparison of three methods for detection of methicillin-resistant Staphylococcus aureus (MRSA) isolates in tertiary health institutions in Nigeria. Canadian Open Biological Sciences Journal, 1 (1), 1–12.
[5] Delialioglu N, Aslan G, Ozturk C, Baki V, Sen S, and Emekdas G. (2005). Inducible clindamycin resistance in staphylococci isolated from clinical samples. Japan Journal ofInfectious Disease, 58, 104–106.
[6] Deotale V, Mendiratta DK, Raut U, and Narang P (2010). Inducible clindamycin resistance in Staphylococcus aureusisolated from clinical samples. Indian Journal Medical Microbiology, 28,124–126.
[7] Leclercq R., R. B. Giannattasio, H. J. Jin, and B. Weisblum (1991). Bacterial resistance to macrolide, lincosamide and streptogramin antibiotics by target modification. Antimicrobial Agents Chemotherapy, 35,1267-1272.
[8] Weisblum B (1999) Resistance to macrolide-lincosamide-streptogramin antibiotics, p. 682-98. In: V. A. Fischetti (ed.), Gram-positive pathogens. American Society for Microbiology, Washington, D. C.
[9] Woods, C. R (2009). Macrolide-inducible resistance to clindamycin and the D-test. Pediatric Infectious Diseases Journal, 28, 1115-1118.
[10] Leclercq R. (2002). Mechanisms of resistance to macrolides and lincosamides: Nature of the resistance elements and their clinical implications. Clinical Infectious Diseases, 34, 482-492.
[11] Drinkovic D, Fuller ER, Shore KP, Holland DJ, and Ellis-Pegler R (2001) Clindamycin treatment of Staphylococcus aureus expressing inducible clindamycin resistance. Journal of Antimicrobial Chemotherapy, 48, 315-316.
[12] Fiebelkorn K. R., Crawford S. A., McElmeel M. L., and Jorgensen J. H (2003). Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulasenegative staphylococci. Journal Clinical of Microbiology; 41, 4740-4744.
[13] Siberry GK, Tekle T, Carroll K, and Dick J (2003). Failure of clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clinical Infectious Diseases,37, 1257-1260.
[14] Garner, J. S., Jarvis, W. R., Emori, T. G., Horan T. C. and Hughes, J. M. (1988). CDC definitions for nosocomial infections. American Journal of Infection Control, 16, 128-140.
[15] Cheesbrough, M. (2000). District laboratory practice in tropical countries (2), Cambridge University press, UK.
[16] Bauer, A. W., Kriby, W. M., Sherris, W. M. and Turk, J. C. (1966). Bauer-Kirbystandardized, single disc susceptibility, test for rapid growing pathogens. AmericanJournal of ClinicalPathology, 45, 493-498.
[17] Ajantha GS, Kulkarni RD, Shetty J, Shubhada C, and Jain P. (2008). Phenotypic detection of inducible clindamycin resistance among Staphylococcus aureus isolates by using the lower limit of recommended inter-disk distance. Indian Journal of Pathology Microbiology, 51, 376-378.
[18] Prabhu K, Rao S, and Rao V. (2011). Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Journal of Laboratory Physicians, 3, 25-27.
[19] Goyal R, Singh NP, Manchanda V, Mathur M. (2004). Detection of clindamycin susceptibility in macrolide resistant phenotypes of Staphylococcus aureus. Indian Journal Medical Microbiology, 22, 251-254.
[20] Shittu, A. O. and Lin, J. (2006). Antimicrobial susceptibility patterns and characterization of clinical isolates of Staphylococcus aureus in KwaZulu-Natal province, South Africa. BioMed Central Journal of Infectious Disease, 6(1), 125-137.
[21] Levin, T. P., Suh, B., Axelrod, P., Truant, A. L. and Fekete, T. (2005). Potential clindamycin resistance in clindamycin-susceptible, erythromycin-resistant Staphylococcus aureus: report of a clinical failure. Antimicrobial Agents and Chemotherapy, 49, 1222–1224.
[22] National Committee for Clinical Laboratory Standards (2004). Performance standards for antimicrobial disk susceptibility tests. 12th informational document NCCLS document M100-S14 2004, PA-NCCLS.
[23] Koppada R., Meeniga S., and Anke G (2015). Inducible Clindamycin Resistance among Staphylococcusaureus Isolated From Various Clinical Samples with Special Reference to MRSA. Scholars Journal of Applied Medical Sciences, 3(6D), 2374-2380.
[24] Baiu, S. H. and Al-Abdli, N. E. (2016). Inducible Clindamycin Resistance in Methicillin Resistant Staphylococcus aureus. American Journal of Infectious Diseases and Microbiology, 4(1), 25-27.
Author Information
  • Department of Medical Laboratory Science, Rivers State University of Science and Technology, Port Harcourt, Nigeria

  • Department of Medical Laboratory Science, Rivers State University of Science and Technology, Port Harcourt, Nigeria

Cite This Article
  • APA Style

    Easter Godwin Nwokah, Samuel Douglas Abbey. (2016). Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria. American Journal of Clinical and Experimental Medicine, 4(3), 50-55. https://doi.org/10.11648/j.ajcem.20160403.13

    Copy | Download

    ACS Style

    Easter Godwin Nwokah; Samuel Douglas Abbey. Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria. Am. J. Clin. Exp. Med. 2016, 4(3), 50-55. doi: 10.11648/j.ajcem.20160403.13

    Copy | Download

    AMA Style

    Easter Godwin Nwokah, Samuel Douglas Abbey. Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria. Am J Clin Exp Med. 2016;4(3):50-55. doi: 10.11648/j.ajcem.20160403.13

    Copy | Download

  • @article{10.11648/j.ajcem.20160403.13,
      author = {Easter Godwin Nwokah and Samuel Douglas Abbey},
      title = {Inducible-Clindamycin Resistance in Staphylococcus aureus  Isolates in Rivers State, Nigeria},
      journal = {American Journal of Clinical and Experimental Medicine},
      volume = {4},
      number = {3},
      pages = {50-55},
      doi = {10.11648/j.ajcem.20160403.13},
      url = {https://doi.org/10.11648/j.ajcem.20160403.13},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajcem.20160403.13},
      abstract = {Clindamycin is indicated in the treatment of skin and soft-tissue infections caused by Staphylococcal species. Treatment of an infection caused by a strain carrying inducible erm  gene using clindamycin or any non-inducer macrolide can lead to clinical failure. The present study was aimed to detect inducible-clindamycin resistance (MLSBi) among S. aureus  isolates in Port Harcourt, Nigeriaand to study the relationship between clindamycin and methicillin-resistant  (MRSA).Two hundred and five (205) non-duplicate  Staphylococcus aureus  previously isolated from human sources were randomly collected from three health facilities- University of Port Harcourt Teaching Hospital, Braithwaite Memorial Specialist Hospital and De-Integrated Laboratories-all located in Port Harcourt, Nigeria, for this study from August, 2012 to July, 2013. Isolates were grouped as hospital in-patient (termed hospital- acquired – Nosocomial; n = 76) and out- patient cases (community-acquired; n = 129) Staphylococcus aureus . The isolates collected were reconfirmed following standard laboratory protocols. All confirmed isolates were stored in glycerol at +4°C (later sub-cultured for various phenotypic analyses). Using the disk diffusion method, detection of MRSA was carried out with 1μg of oxacillin (OXOID) placed on Mueller-Hinton agar with 4% NaCl supplementation).Antimicrobial susceptibility testing was performed using Erythromycin (15μg) and Clindamycin (2μg) both obtained from OXOID, UK. All clindamycin-sensitive isolates that were also erythromycin-resistant were subjected to D-Test phenotype (Inducible-clindamycin resistance). Among the 205 S. aureus  isolates studied, Forty-four (21.5%) showed resistance to erythromycin, while 38 of these erythromycin-resistant isolates were simultaneously sensitive to clindamycin. Overall, out of 205 isolates, inducible-clindamycin resistance was detected in 23 (11.2%) of the isolates. These 23 (inducible MLSB phenotype) are among 38 erythromycin-resistant S. aureus that were simultaneously sensitive (phenotypically) to clindamycin. Ten (4.9%) of the total (205) study isolates expressed constitutive resistance to clindamycin. Oxacillin Resistance (MRSA) was detected in 25 (12.2%) of the 205 isolates. Among the 38 erythromycin-resistant S. aureus, four were MRSA while 3 (75%) of the 4 erythromycin-resistant MRSA expressed inducible resistance to clindamycin. 20 (58.8%) of 34 erythromycin-resistant MSSA expressed inducible resistance to clindamycin. MRSA phenotype was not significantly correlated (p=0.9430) to inducible-clindamycin resistance. Inducible clindamycin-resistance often leads to treatment failure. The clinical microbiology laboratories in Nigeria should consider routine testing and reporting of inducible clindamycin resistance in S. aureus . There is also the need for sustained surveillance of antimicrobial susceptibilities of S. aureus  in this region.},
     year = {2016}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Inducible-Clindamycin Resistance in Staphylococcus aureus  Isolates in Rivers State, Nigeria
    AU  - Easter Godwin Nwokah
    AU  - Samuel Douglas Abbey
    Y1  - 2016/05/11
    PY  - 2016
    N1  - https://doi.org/10.11648/j.ajcem.20160403.13
    DO  - 10.11648/j.ajcem.20160403.13
    T2  - American Journal of Clinical and Experimental Medicine
    JF  - American Journal of Clinical and Experimental Medicine
    JO  - American Journal of Clinical and Experimental Medicine
    SP  - 50
    EP  - 55
    PB  - Science Publishing Group
    SN  - 2330-8133
    UR  - https://doi.org/10.11648/j.ajcem.20160403.13
    AB  - Clindamycin is indicated in the treatment of skin and soft-tissue infections caused by Staphylococcal species. Treatment of an infection caused by a strain carrying inducible erm  gene using clindamycin or any non-inducer macrolide can lead to clinical failure. The present study was aimed to detect inducible-clindamycin resistance (MLSBi) among S. aureus  isolates in Port Harcourt, Nigeriaand to study the relationship between clindamycin and methicillin-resistant  (MRSA).Two hundred and five (205) non-duplicate  Staphylococcus aureus  previously isolated from human sources were randomly collected from three health facilities- University of Port Harcourt Teaching Hospital, Braithwaite Memorial Specialist Hospital and De-Integrated Laboratories-all located in Port Harcourt, Nigeria, for this study from August, 2012 to July, 2013. Isolates were grouped as hospital in-patient (termed hospital- acquired – Nosocomial; n = 76) and out- patient cases (community-acquired; n = 129) Staphylococcus aureus . The isolates collected were reconfirmed following standard laboratory protocols. All confirmed isolates were stored in glycerol at +4°C (later sub-cultured for various phenotypic analyses). Using the disk diffusion method, detection of MRSA was carried out with 1μg of oxacillin (OXOID) placed on Mueller-Hinton agar with 4% NaCl supplementation).Antimicrobial susceptibility testing was performed using Erythromycin (15μg) and Clindamycin (2μg) both obtained from OXOID, UK. All clindamycin-sensitive isolates that were also erythromycin-resistant were subjected to D-Test phenotype (Inducible-clindamycin resistance). Among the 205 S. aureus  isolates studied, Forty-four (21.5%) showed resistance to erythromycin, while 38 of these erythromycin-resistant isolates were simultaneously sensitive to clindamycin. Overall, out of 205 isolates, inducible-clindamycin resistance was detected in 23 (11.2%) of the isolates. These 23 (inducible MLSB phenotype) are among 38 erythromycin-resistant S. aureus that were simultaneously sensitive (phenotypically) to clindamycin. Ten (4.9%) of the total (205) study isolates expressed constitutive resistance to clindamycin. Oxacillin Resistance (MRSA) was detected in 25 (12.2%) of the 205 isolates. Among the 38 erythromycin-resistant S. aureus, four were MRSA while 3 (75%) of the 4 erythromycin-resistant MRSA expressed inducible resistance to clindamycin. 20 (58.8%) of 34 erythromycin-resistant MSSA expressed inducible resistance to clindamycin. MRSA phenotype was not significantly correlated (p=0.9430) to inducible-clindamycin resistance. Inducible clindamycin-resistance often leads to treatment failure. The clinical microbiology laboratories in Nigeria should consider routine testing and reporting of inducible clindamycin resistance in S. aureus . There is also the need for sustained surveillance of antimicrobial susceptibilities of S. aureus  in this region.
    VL  - 4
    IS  - 3
    ER  - 

    Copy | Download

  • Sections