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Almuhayawi MS, Alruhaili MH, Gattan HS, Alharbi MT, Nagshabandi M, Al Jaouni S, Selim S, Alanazi A, Alruwaili Y, Faried OA, Elnosary ME. Staphylococcus aureus Induced Wound Infections Which Antimicrobial Resistance, Methicillin- and Vancomycin-Resistant: Assessment of Emergence and Cross Sectional Study. Infect Drug Resist 2023; 16:5335-5346. [PMID: 37605760 PMCID: PMC10440082 DOI: 10.2147/idr.s418681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
Background Wound infection is a prevalent concern in the medical field, being is a multi-step process involving several biological processes. Methicillin-resistant S. aureus (MRSA) and vancomycin-resistant S. aureus (VRSA) infections often occur in areas of damaged skin, such as abrasions and open wounds. Methods This research aims to light the incidence of MRSA and VRSA in wound swabs, the antimicrobial susceptibility configuration of isolated S. aureus patterns in pus/wound samples collected from Saudi Arabian tertiary hospital. The cross section study, β- lactamase detection, VRSA genotyping, MAR index, D-test and VRSA genotyping are methods, which used for completed this research. Results Patients of several ages and genders delivered specimens from two hospitals in the Al jouf area, in the northern province of Saudi Arabia. S. aureus was found in 188 (34.7%) of the 542 wounds. The traumatized wounds provided 71 isolates (38.8%), surgical wound provided 49 isolates (26.8%) and abscess were represented 16 by isolates (8.7%). In the study, 123 (65.4%) out of 188 were MRSA, 60 (31.9%) were MSSA, and five (2.7%) were VRSA. Linezolid and rifampin were found to be the most effective antimicrobials with 100% in vitro antibacterial activity against S. aureus isolates. The Multiple antimicrobials resistance (MAR) index revealed 73 isolates (38.9%) with a MAR index greater than 0.2, and 115 (61.1%) less than 0.2. The D-test showed that of MLSb phenotypes among S. aureus, 22 (11.7%) strains were D-test positive (MLSbi phenotype), 53 (28.2%) strains were constitutive MLSc phenotypes, and 17 (9%) strains were shown to have MSb phenotypes. All VRSA isolates (n=5) were found to be positive for vanA, and no vanB positive isolates were detected in the study. Conclusion Regular monitoring and an antimicrobials stewardship program should be in place to provide critical information that can be utilized for empirical therapy and future prevention strategies.
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Affiliation(s)
- Mohammed S Almuhayawi
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Mohammed H Alruhaili
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King AbdulAziz University, Jeddah, Saudi Arabia
- Special Infectious Agents Unit, King Fahad Medical Research Center, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Hattan S Gattan
- Special Infectious Agents Unit, King Fahad Medical Research Center, King AbdulAziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohanned Talal Alharbi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, University of Jeddah, Jeddah, 23218, Saudi Arabia
| | - Mohammed Nagshabandi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, University of Jeddah, Jeddah, 23218, Saudi Arabia
| | - Soad Al Jaouni
- Department of Hematology/Oncology, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
- Yousef Abdulatif Jameel Scientific Chair of Prophetic Medicine Application, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Samy Selim
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Awadh Alanazi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Yasir Alruwaili
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Osama Ahmed Faried
- Medical Microbiology and Immunology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed E Elnosary
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, Egypt
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Timsina R, Shrestha U, Singh A, Timalsina B. Inducible clindamycin resistance and erm genes in Staphylococcus aureus in school children in Kathmandu, Nepal. Future Sci OA 2020; 7:FSO361. [PMID: 33437500 DOI: 10.2144/fsoa-2020-0092] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Resistance to methicillin and Macrolide–Lincosamide and Streptogramins B and their association with erm genes in Staphylococcus aureus are unknown in Nepal. Materials & methods: Nonduplicate nasal swabs from 160 school children were collected from April to September 2018 and processed using standard microbiological procedures. Results: Out of 160 samples, 64 (40%) were S. aureus in which 17 (26.6%) were methicillin-resistance Staphylococcus aureus (MRSA). D-test identified 15 (23.4%) as inducible clindamycin-resistant, which were more prevalent in MRSA (76.4%) than methicillin-sensitive S. aureus (MSSA; 4.2%). 18.7% of isolates harbored the ermC gene followed by ermA (15.6%) and ermB (3.1%), and were more in MRSA than MSSA. Conclusion: To prevent treatment failure by inducible resistance, D-test must be performed on erythromycin-resistant and/or clindamycin-sensitive isolates. With the increased prevalence of methicillin-resistant S. aureus in hospital- and community-acquired infections, there has been an upsurge in resistance toward Macrolide–Lincosamide–Streptogramin type B antibiotics. This has rendered therapy difficult, thereby increasing morbidity, length of hospital-stay and cost of treatment. Therefore, the correct identification and reporting of S. aureus isolates and their susceptibility patterns, more specifically, toward methicillin, clindamycin and erythromycin is very crucial.
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Novosak M, Bobadilla F, Delgado O, Vergara M, Laczeski M. Phenotypic and Genotypic Characterization of Resistance to Macrolides and Lincosamides in Streptococcus agalactiae Isolated from Pregnant Women in Misiones, Argentina. Microb Drug Resist 2020; 26:1472-1481. [PMID: 32315569 DOI: 10.1089/mdr.2019.0328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The aim of this work was to determine the susceptibility, molecular profile, and clonal relationship in Streptococcus agalactiae (group B Streptococcus [GBS]) isolated from vaginal-rectal swab samples. We worked with 200 isolates collected from pregnant women between 35 and 37 weeks of gestation. The macrolide-lincosamide-streptogramin B (MLSB) resistance phenotypes were determined using the double-disc assay. Susceptibility to erythromycin (ERI) and clindamycin (CLI) was performed with the E-test. Resistance genes ermB and ermTR were detected by polymerase chain reaction. Clonal studies were performed using the random amplification of polymorphic DNA. Twelve (6%) of the isolates were resistant to ERI and 10 (5%) of them to CLI. Fifty percent of the resistant strains corresponded to serotype III, 25% to serotype V, and the remaining 25% to serotype Ia, II, and nontypeable strains. The cMLSB phenotype was detected in eight strains (66.67%) and the iMLSB phenotype in four (33.33%). The minimum inhibitory concentration values were between 1.5 and 16 μg/mL for ERI, and between 1 and 32 μg/mL for CLI. Out of the 25 strains susceptible to ERI and CLI, the presence of the ermB gene was detected in eight of them and the ermTR gene in one strain. The ermB gene was detected in the 12 strains that initially had some macrolide resistance phenotype. The ermTR gene was detected in three out of the four strains with the iMLSB phenotype. The resistance to macrolides in the province of Misiones is due to multiclonal spread. The phenotypic and genotypic characterization of macrolide resistance in GBS strains are crucial to contribute to the correct intrapartum prophylactic antibiotic therapy of allergic pregnant women and the epidemiological surveillance of these strains.
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Affiliation(s)
- Marina Novosak
- Cátedra de Bacteriología, Departamento de Microbiología, Facultad de Ciencias Exactas, Químicas y Naturales (FCEQyN), Universidad Nacional de Misiones (UNaM), Misiones, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Fernando Bobadilla
- Cátedra de Bacteriología, Departamento de Microbiología, Facultad de Ciencias Exactas, Químicas y Naturales (FCEQyN), Universidad Nacional de Misiones (UNaM), Misiones, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Osvaldo Delgado
- Planta Piloto de Procesos Industriales Microbiológicos (PROIMI-CONICET), Tucumán, Argentina.,Centro de Biología Molecular y Biotecnología (CEBIOTEC), Facultad de Ciencias Exactas y Naturales (FACEN), Universidad Nacional de Catamarca (UNCa), Catamarca, Argentina
| | - Marta Vergara
- Cátedra de Bacteriología, Departamento de Microbiología, Facultad de Ciencias Exactas, Químicas y Naturales (FCEQyN), Universidad Nacional de Misiones (UNaM), Misiones, Argentina
| | - Margarita Laczeski
- Cátedra de Bacteriología, Departamento de Microbiología, Facultad de Ciencias Exactas, Químicas y Naturales (FCEQyN), Universidad Nacional de Misiones (UNaM), Misiones, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.,Laboratorio de Biotecnología Molecular, Instituto de Biotecnología Misiones "Dra. María Ebe Reca" (InBioMis), FCEQyN, UNaM, Misiones, Argentina
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Pardo L, Machado V, Cuello D, Aguerrebere P, Seija V, Braga V, Varela G. Macrolide-lincosamide-streptogramin B resistance phenotypes and their associated genotypes in Staphylococcus aureus isolates from a tertiary level public hospital of Uruguay. Rev Argent Microbiol 2020; 52:202-210. [PMID: 31928835 DOI: 10.1016/j.ram.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/27/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022] Open
Abstract
This study was undertaken to investigate the resistance phenotypes to macrolide-lincosamide-streptogramin B (MLSB) antibiotics and their associated genotypes in isolates of Staphylococcus aureus. We analyzed one hundred, consecutive, non-duplicate isolates (methicillin-susceptible MSSA, n=53 and methicillin-resistant MRSA, n=47) obtained from various clinical samples between July 2012 to December 2013. The resistance profile to MLSB antibiotics was determined by phenotypic methods and the resistance genes were detected by PCR assays. All of the isolates were subjected to pulsed-field gel electrophoresis (SmaI-PFGE). The overall prevalence of resistance to MLSB antibiotics was 38% and the resistance phenotype distribution was as follows: cMLSB, 22%; iMLSB, 10%; MSB, 5% and L, 1%. We detected ermA, ermC, ermB and mrsA/B genes in these resistant isolates. The single ermA gene was commonly observed mainly in those with a cMLSB R phenotype, whereas the combination ermA and ermC was more commonly observed in isolates with inducible expression. The patterns of SmaI-PFGE suggest a great genetic diversity in both MRSA and MSSA resistant to MLSB antibiotics. The results demonstrate the local presence of S. aureus resistant to MLSB antibiotics and its most frequently described responsible genes. Some of these isolates, especially those with the iMLSB phenotype, may be associated with therapeutic failure. Therefore, efforts should be directed to the correct detection of all MLSB resistant isolates using appropriate laboratory tests. PFGE results reveal a wide spread of resistance genes rather than the circulation of S. aureus clones resistant to MLSB antibiotics.
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Affiliation(s)
- Lorena Pardo
- Bacteriology and Virology Department, Medicine School, Universidad de la República, Montevideo Alfredo Navarro 3051 (south entrance), 11800, Uruguay
| | - Virginia Machado
- Bacteriology and Virology Department, Medicine School, Universidad de la República, Montevideo Alfredo Navarro 3051 (south entrance), 11800, Uruguay
| | - Dianna Cuello
- Bacteriology and Virology Department, Medicine School, Universidad de la República, Montevideo Alfredo Navarro 3051 (south entrance), 11800, Uruguay
| | - Paula Aguerrebere
- Bacteriology and Virology Department, Medicine School, Universidad de la República, Montevideo Alfredo Navarro 3051 (south entrance), 11800, Uruguay
| | - Verónica Seija
- Bacteriology Laboratory, "Hospital Pasteur", Montevideo, Larravide 2458, 11800, Uruguay; Laboratory of Public Health, Alfredo Navarro 3051 (north-entrance), Montevideo, Uruguay
| | - Valeria Braga
- Bacteriology and Virology Department, Medicine School, Universidad de la República, Montevideo Alfredo Navarro 3051 (south entrance), 11800, Uruguay
| | - Gustavo Varela
- Bacteriology and Virology Department, Medicine School, Universidad de la República, Montevideo Alfredo Navarro 3051 (south entrance), 11800, Uruguay.
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Khan AA, Farooq J, Abid M, Zahra R. Assessment of inducible clindamycin resistance and Hyper Variable Region (HVR) of mecA gene in clinical staphylococci. Pak J Med Sci 2020; 36:136-140. [PMID: 32063947 PMCID: PMC6994918 DOI: 10.12669/pjms.36.2.665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To study the prevalence of inducible clindamycin along with vancomycin and methicillin resistance and assessment of hyper variable region (HVR) of mecA gene among different clinical isolates of Staphylococcus spp. Methods: A total of 176 clinical isolates of Staphylococci were collected from Pakistan Institute of Medical Sciences (PIMS), Islamabad during 2014-2015. The sample sources were pus, blood, urine, sputum, tracheal secretions and tissue fluids. Bacterial identification was done by colony morphology and biochemical tests. Kirby-Bauer disc-diffusion method was carried out to assess the susceptibility against different antibiotics. Minimal inhibitory concentrations (MICs) were done for vancomycin resistance. Double Disk Diffusion test (D-test) was used to detect the clindamycin inducible resistance. PCR was performed to detect erm(C), mecA and HVR genes. Results: Clindamycin inducible resistance among Staphylococcal isolates was found to be 7%, whereas in S. aureus it was 4%, and in coagulase negative Staphylococci (CoNS) it was 11%. The highest resistance was observed against fosfomycin, fusidic acid and cefoxitin. Vancomycin resistance was observed in 23 isolates (13%) of Staphylococci. erm(C), mecA and HVR genes were found in 18%, 50% and 42% respectively. Conclusions: D-test must be performed routinely to avoid clindamycin failure. A high level of resistance against vancomycin in Staphylococcal isolates is a concern for public health.
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Affiliation(s)
- Amir Afzal Khan
- Amir Afzal Khan, Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Jahanzaib Farooq
- Jahanzaib Farooq, Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Madiha Abid
- Madiha Abid, Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Rabaab Zahra
- Rabaab Zahra, Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
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Sedaghat H, Esfahani BN, Mobasherizadeh S, Jazi AS, Halaji M, Sadeghi P, Emaneini M, Havaei SA. Phenotypic and genotypic characterization of macrolide resistance among Staphylococcus aureus isolates in Isfahan, Iran. Iran J Microbiol 2017; 9:264-270. [PMID: 29296270 PMCID: PMC5748444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND OBJECTIVES Macrolide, lincosamide and streptogramin B (MLS B) are noteworthy antibiotics for the treatment of Staphylococcus aureus infections. The purpose of this study, was to determine the phenotypic and genotypic characterization of macrolide resistance, among S. aureus, isolated from clinical samples and nasal swabs. MATERIALS AND METHODS Totally, 162 non-duplicate S. aureus isolates were collected from clinical samples and nasal swabs, from patients and healthcare workers (HCWs), between March 2016 and September 2016, at four teaching hospitals in Isfahan. The antibiotic resistance profile was determined using disk diffusion test and the presence of resistance genes was detected, using PCR. RESULTS Of 162 S. aureus isolates, 43.8% (71/162) and 34% (55/162) isolates were erythromycin-resistant and methicillin-resistant S. aureus (MRSA), respectively. The prevalence of constitutive MLS B (cMLS B), inducible MLS B (iMLS B), macrolide-streptogramin B-resistant (MS B) and lincosamide-streptogramin-A resistance (LS A) phenotype was 32%, 6%, 6% and 2%, respectively. The most common erythromycin resistance genes, in S. aureus isolates were ermC (35.2%), followed by ermA (20.4%) and msrA (17.3%). Meanwhile, msrA was detected in 43.6% of MRSA isolates. The frequency of coexistence of ermA+ermC+msrA, in S. aureus isolates was 7% and it was only detected in MRSA isolates. CONCLUSION In the current study, cMLS B phenotype was the most common erythromycin resistance pattern and ermC was the most prevalent gene in erythromycin-resistant isolates. The results revealed that the various mechanisms of erythromycin resistance are expanding in Isfahan.
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Affiliation(s)
- Hossein Sedaghat
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahram Nasr Esfahani
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sina Mobasherizadeh
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azhar Sallari Jazi
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Halaji
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Sadeghi
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Emaneini
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Asghar Havaei
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Corresponding author: Seyed Asghar Havaei, PhD, Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Tel: +983137922478,
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Saffar H, Rajabiani A, Abdollahi A, Habibi S, Baseri Z. Frequency of inducible clindamycin resistance among gram-positive cocci in a tertiary hospital, Tehran, Iran. Iran J Microbiol 2016; 8:243-248. [PMID: 28210463 PMCID: PMC5296938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND OBJECTIVES Accurate designation of antimicrobial susceptibility pattern of the infecting microorganisms is an important crucial factor in making appropriate therapeutic decisions. Macrolide, lincosamide and streptogramin B antibiotics are in a family, reserved as an alternative approach in treatment of resistant Gram positive cocci. Amongst them, clindamycin has been considered as the preferred agent due to its excellent pharmacokinetic properties. The inducible resistance to clindamycin in Gram positive staphylococci and streptococci cannot be recognized by routine broth or agar based susceptibility tests and D-zone testing is necessary. This study is conducted to evaluate the frequency of inducible clindamycin resistance in Gram positive cocci. MATERIALS AND METHODS Using traditional culture methods, 487 isolates of staphylococcus and β-hemolytic streptococcus were evaluated. If they were resistant to erythromycin and sensitive to clindamycin in primary antibiotic susceptibility testing by Kirby-Bauer method, they were subjected to D-zone testing to detect possible inducible clindamycin resistance. RESULTS Thirty three out of 172 isolates of Staphylococcus aureus and 50 out of 277 isolates of coagulase-negative staphylococci (CoNS) were subjected for D-zone testing. Among them 13/33 and 28/50 showed inducible clindamycin resistance, respectively. There was no significant difference in inducible clindamycin resistance regarding to methicillin susceptibility pattern. Positive D-test was observed in 17.39 and 13.33% of Group B streptococci and Streptococcus spp., respectively. CONCLUSION Considerable number of isolates showed inducible clindamycin resistance in our study which falsely would be reported susceptible if D-zone testing was not performed. Thus, performing D-Zone testing is necessary to avoid misleading results which may cause treatment failure.
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Affiliation(s)
- Hiva Saffar
- Department of Pathology and Laboratory Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author: Hiva Saffar, Ph.D, Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Phone: +98 21 84902187, Fax: +98 21 84902187, E-mail:
| | - Afsaneh Rajabiani
- Department of Pathology and Laboratory Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Abdollahi
- Department of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Habibi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Baseri
- Department of Pathology and Laboratory Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Majhi S, Dash M, Mohapatra D, Mohapatra A, Chayani N. Detection of inducible and constitutive clindamycin resistance among Staphylococcus aureus isolates in a tertiary care hospital, Eastern India. Avicenna J Med 2016; 6:75-80. [PMID: 27390669 PMCID: PMC4922212 DOI: 10.4103/2231-0770.184066] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Clindamycin is an excellent drug for skin and soft tissue Staphylococcus aureus infections, but resistance mediated by inducible macrolide-lincosamide-streptogramin B (iMLSB) 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 iMLSB 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 (iMLSB 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.
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Affiliation(s)
- 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
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Hosseini SS, Niakan M, Saderi H, Motallebi M, Taherikalani M, Asadollahi K, Emaneini M. Frequency of genes encoding erythromycin ribosomal methylases among Staphylococcus aureus clinical isolates with different D-phenotypes in Tehran, Iran. Iran J Microbiol 2016; 8:161-167. [PMID: 27928482 PMCID: PMC5139918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Macrolide, lincosamide and streptogramin type B (MLSB) antibiotics are important in the treatment of Staphylococcus aureus infections and existence of isolates with ability to resist against MLSB antibiotics is worrisome. MATERIALS AND METHODS In this cross sectional study, 101 S. aureus isolates were collected from patients of five selected hospitals in Tehran over a period of five months. Disk diffusion tests and differentiation between constitutive and inducible resistances were carried out by D-test. The presence of mecA, msrA, ermA and ermC genes were detected using PCR or multiplex PCR. RESULTS Out of 101 S. aureus isolates, 58 (57.4%) were methicillin resistant and 57 (56.4%) expressed resistance to erythromycin. The prevalence of constitutive MLSB (cMLSB), inducible MLSB (iMLSB) and MS (Negative) phenotype in all erythromycin resistant isolates were 71.9, 26.3 and 1.7%, respectively. Out of all the erythromycin resistant isolates, 57.8% harbored both ermA and ermC genes which possessed constitutive resistance. 8.7% of the isolates contained ermA gene alone which possessed inducible resistance with D phenotype and 5.2% of isolates just contained ermC gene which had inducible resistance with D+ phenotype. msrA gene was detected in 3.5% of the erythromycin resistant S. aureus isolates with constitutive resistance. None of the genes were detected among MS phenotypes. CONCLUSION In this study, most of S. aureus isolates carried both ermA and ermC genes and there was a significant relationship (P value ≤ 0.05) between different resistance phenotypes and erm genes.
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Affiliation(s)
| | - Mohammad Niakan
- Department of Microbiology, School of Medicine, Shahed University, Tehran, Iran
| | - Horieh Saderi
- Molecular Microbiology Research Center, School of Medicine, Shahed University, Tehran, Iran
| | - Mitra Motallebi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Morovat Taherikalani
- Razi Herbal Medicines Research Center & Department of Microbiology, School of Medicine, Lorestan University of Medical Sciences, Ilam, Iran
| | - Khairollah Asadollahi
- Department of Social Medicine, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Emaneini
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Corresponding author: Mohammad Emaneini, Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, No. 100, Poursina St., Keshavarz Blvd., Tehran, Iran., Tel- Fax: +98 21 88955810,
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Ghanbari F, Ghajavand H, Havaei R, Jami MS, Khademi F, Heydari L, Shahin M, Havaei SA. Distribution of erm genes among Staphylococcus aureus isolates with inducible resistance to clindamycin in Isfahan, Iran. Adv Biomed Res 2016; 5:62. [PMID: 27135031 PMCID: PMC4832884 DOI: 10.4103/2277-9175.179184] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/24/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The rising frequency of methicillin resistant Staphylococcus aureus (MRSA) has led to an increased use of antibiotics such as macrolide, lincosamide, streptogramin B (MLSB) for the treatment of S. aureus infections. Resistance to MLSB in S. aureus is commonly encoded by erm genes, which can be constitutive MLSB (cMLSB) or inducible MLSB (iMLSB). The purpose of this study was to determine the frequency of cMLSB, iMLSB, and MS phenotypes using D-test and polymerase chain reaction (PCR) methods. MATERIALS AND METHODS A total of 215 isolates of S. aureus were collected from January 2010 to May 2012 from Al-Zahra Hospital in Isfahan. PCR was performed for detection of mecA gene on all isolates using specific primers. The frequency of MLSB-resistant isolates was determined using D-test, and then a multiplex PCR was performed for detection of ermA, ermB, and ermC genes. RESULTS Among 215 S. aureus isolates examined, 82 (40.9%) were MRSA, and iMLSB, cMLSB, and MS resistance phenotypes had a frequency of 9 (4.18%), 58 (26.9%), and 11 (5.1%), respectively. Among nine isolates with iMLSB resistance phenotype, four isolates contained ermC gene, two isolates ermB gene, and one isolate ermA gene. Two isolates did not have any erm gene. CONCLUSION In the current study, cMLSB was the most frequent phenotype and ermC was the most common gene in iMLSB resistant phenotypes.
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Affiliation(s)
- Fahimeh Ghanbari
- Department of Microbiology, Faculty of Bioscience, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - Hasan Ghajavand
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roholla Havaei
- Department of Endodontics, School of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad-Saeid Jami
- Cellular and Molecular Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Farzad Khademi
- Department of Medical Bacteriology and Virology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Heydari
- Department of Microbiology, Faculty of Bioscience, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - Mojtaba Shahin
- Department of Microbiology, School of Medicine, Ahvaz University of Medical Sciences, Ahvaz, Iran
| | - Seyed Asghar Havaei
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Toka Özer T. The Rate of Inducible MLSB Resistance in the Methicillin-Resistant Staphylococci Isolated From Clinical Samples. J Clin Lab Anal 2015; 30:490-3. [PMID: 26494564 DOI: 10.1002/jcla.21884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 04/13/2015] [Accepted: 07/25/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Staphylococci are one of the most common pathogens in nasocomial and community-acquired infections. Methicillin-resistant staphylococci are known to be resistant against all beta-lactam antibiotics. Therefore, non-beta-lactam antibiotics such as macrolide and lincosamides can be used. Resistance to those antibiotics may lead to therapeutic failure. The purpose of the present study was to determine the prevalence of macrolide-lincosamide-streptogramin B (MLSB ) resistance by using D-test in staphylococcal isolates from various clinical samples. METHODS Seventy-one methicillin-resistant Staphylococcus isolates (six S. aureus, 65 coagulase negative staphylococci) were included in this study. Staphylococci were identified with conventional methods. According to Clinical Laboratory Standards Institute (CLSI) criteria, susceptibility testing was performed by Kirby-Bauer disk diffusion method. RESULTS One of six (16.6%) methicillin-resistant S. aureus isolates and 19 of 65 (29.2%) methicillin-resistant coagulase-negative staphylococci (MR-CNS) were detected as D-test positive. Twenty of 71 (28.1%) staphylococcal isolates detected as D-test positive. Inducible clindamycin resistance was found at a higher rate in MR-CNS. CONCLUSION Since the resistant community and hospital acquired staphylococcal infections have become a therapeutic problem, it is very important to detect MLSB resistance routinely in microbiology laboratories. D-test is a cheap and reliable diagnostic method that can be performed in every laboratory.
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Affiliation(s)
- Türkan Toka Özer
- Department of Medical Microbiology, Faculty of Medicine, Mevlana University, Konya, Turkey.
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Dubey D, Rath S, Sahu MC, Rout S, Debata NK, Padhy RN. A report on infection dynamics of inducible clindamycin resistance of Staphylococcus aureus isolated from a teaching hospital in India. Asian Pac J Trop Biomed 2015; 3:148-53. [PMID: 23593595 DOI: 10.1016/s2221-1691(13)60040-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/28/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To investigate the infection of hospital- and community-acquired "erythromycin-induced clindamycin resistant" strains or D-test positives of clinical isolates of Staphylococcus aureus (S. aureus) (with and without methicillin resistance) in a hospital. METHODS Strains of S. aureus isolated from clinical specimens were subjected to D-test and antibiotic profiling. RESULTS Of the total 278 isolates, 140 (50.35%) were D-test positives and the rest were D-test negatives. Further, of 140 (100%) positives, 87 (62.14%) and 53 (37.85%) strains were from males and females, respectively. Of 140 (100%) positives, 117 (83.57%) were methicillin resistant S. aureus and 23 (16.42%) were methicillin sensitive S. aureus; of 140 strains, 103 (73.57%) strains from persons with and 37 (26.42%) were without related infections; of 140 strains, 91 (65%) and 49 (35%) were from hospital- and community-acquired samples, respectively. In 140 strains, 118 (84.28%) with comorbidities and 22 (15.71%) without comorbidities cases were recorded; similarly, persons with prior antibiotic uses contributed 108 (77.14%) and without 32 (22.85%) positive strains. These binary data of surveillance were analyzed by a univariate analysis. It was evident that the prior antibiotic uses and comorbidities due to other ailments were the determinative factors in D-test positivity, corroborated by low P values, P=0.001 1 and 0.002 4, respectively. All isolates (278) were resistant to 17 antibiotics of nine groups, in varying degrees; the minimum of 28% resistance for vancomycin and the maximum of 97% resistance for gentamicin were recorded. Further, of 278 strains, only 42 (15.1%) strains were resistant constitutively to both antibiotics, erythromycin resistant and clindamycin resistant, while 45 (16.2%) strains were constitutively sensitive to both antibiotics (erythromycin sensitive and clindamycin sensitive). Further, of the rest 191 (68.7%) strains were with erythromycin resistant and clindamycin resistant, of which only 140 (50.35%) strains were D-test positives, while the rest 51 (18.34%) strains were D-test negatives. CONCLUSIONS In view of high prevalence of D-test positive S. aureus strains, and equally high prevalence of multidrug resistant strains both in community and hospital sectors, undertaking of D-test may be routinely conducted for suppurative infections.
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Affiliation(s)
- Debasmita Dubey
- Microbiology Department, IMS & Sum Hospital, Siksha 'O' Anusandhan University, Kalinga Nagar, Bhubaneswar 751003, Odisha, India
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Abstract
The prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) has steadily increased over the past 40 years. Today, intravenous clindamycin or vancomycin is recommended for anti-staphylococcal coverage. Failure to identify resistant strains could result in the overuse of vancomycin and subsequent resistance to that antibiotic. Concerns over the emergence of this pathogen has caused many hospital laboratories to reassess their ability to identify antibiogram patterns and epidemiological shifts, determine appropriate laboratory testing, and review empiric therapy guidelines. Reliance on automated instrumentation to detect these isolates can result in major errors that cause false susceptible interpretations. The emergence of methicillin/oxacillin resistant strains has required additional laboratory analysis. This paper will review these tests and will focus on the role of the "D-test" in directing antibiotic therapy.
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Affiliation(s)
- Toni Beavers-May
- Microbiology Section, Clinical Laboratory, Little Rock, Arkansas ; Arkansas Children's Hospital, Little Rock, Arkansas
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