American Journal of Clinical and Experimental Medicine
Volume 4, Issue 3, May 2016, Pages: 50-55
Received: Mar. 20, 2016;
Accepted: Mar. 30, 2016;
Published: May 11, 2016
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Easter Godwin Nwokah, Department of Medical Laboratory Science, Rivers State University of Science and Technology, Port Harcourt, Nigeria
Samuel Douglas Abbey, Department of Medical Laboratory Science, Rivers State University of Science and Technology, Port Harcourt, Nigeria
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.
Easter Godwin Nwokah,
Samuel Douglas Abbey,
Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria, American Journal of Clinical and Experimental Medicine.
Vol. 4, No. 3,
2016, pp. 50-55.
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.
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.
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.
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.
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.
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.
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.
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.
Woods, C. R (2009). Macrolide-inducible resistance to clindamycin and the D-test. Pediatric Infectious Diseases Journal, 28, 1115-1118.
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.
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.
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.
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.
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.
Cheesbrough, M. (2000). District laboratory practice in tropical countries (2), Cambridge University press, UK.
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.
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.
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.
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.
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.
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.
National Committee for Clinical Laboratory Standards (2004). Performance standards for antimicrobial disk susceptibility tests. 12th informational document NCCLS document M100-S14 2004, PA-NCCLS.
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.
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.