Inducible clindamycin resistance in Staphylococci: should clinicians and microbiologists be concerned?

Area of Science:

• Infectious Diseases
• Microbiology
• Pharmacology

Background:

• Rising incidence of Staphylococcus aureus infections, particularly community-associated methicillin-resistant S. aureus (MRSA).
• MRSA strains often exhibit susceptibility to non-beta-lactam agents, unlike healthcare-associated strains.
• Need for safe, effective, and accessible treatments for staphylococcal infections.

Purpose of the Study:

• To evaluate clindamycin as an oral treatment for community-acquired MRSA infections.
• To address concerns regarding the emergence of clindamycin resistance during therapy.
• To highlight diagnostic methods for predicting clindamycin resistance.

Main Methods:

• Review of existing literature on MRSA treatment options.
• Analysis of clindamycin's efficacy in treating various MRSA infections (pneumonia, soft-tissue, musculoskeletal).
• Discussion of the erythromycin-clindamycin D-zone test for detecting inducible clindamycin resistance.

Main Results:

• Clindamycin is an effective oral agent for localized community-acquired MRSA infections in adults and children.
• Concerns exist about potential clindamycin resistance development during treatment.
• The D-zone test can identify MRSA strains with erm genes, indicating a risk of inducible resistance.

Conclusions:

• Clindamycin remains a valuable therapeutic option for community-acquired MRSA infections.
• Pre-treatment susceptibility testing, such as the D-zone test, is crucial to guide therapy and mitigate resistance.
• Accessible oral agents like clindamycin are vital for managing widespread staphylococcal infections.