Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria
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
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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.
Staphylococcus aureus , MRSA, Erythromycin- Resistance, Inducible-Clindamycin Resistance
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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. doi: 10.11648/j.ajcem.20160403.13
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