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Inducible Clindamycin Resistant Staphylococcus aureus among Patients Attending Tertiary Care Centre: A Descriptive
Shanti Pradhan1, Sanjib Mani Regmi1, Nabina Shrestha1
1Gandaki Medical College and Teaching Hospital and Research Centre, Pokhara, Nepal.
Introduction:
Staphylococcus aureus, a superbug, resistant to multiple antibiotics led to growing interest in the usage of macrolide-lincosamide-streptogramin B antibiotics, which are now rapidly developing resistance. This study aims to find the prevalence of inducible clindamycin-resistant Staphylococcus aureus among obtained clinical samples from in-patient and out-patient departments of a tertiary care center.
Methods:
This is a descriptive cross-sectional study done in clinical samples from the in-patient and out-patient departments of a tertiary care center from September 2020-May 2021. Ethical clearance was taken from the Institutional Review Committee (Ref: 068/2077/2078). Staphylococcus aureus were isolated and antibiotic susceptibility tests were performed by disc diffusion method. Inducible clindamycin and methicillin resistance Staphylococcus aureus were detected using D-test and cefoxitin disc according to Clinical and Laboratory Standards Institute guidelines. Convenient sampling was done and the data was analyzed using Statistical Package for Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.
Results:
Among a total of 141 Staphylococcus aureus isolated, the prevalence of inducible clindamycin resistant phenotype was 41 (29.1%) (21.6-36.59 at 95% Confidence Interval). Whereas, 30 (21.3%) were constitutive clindamycin resistant. The inducible 28 (47.5%) and 19 (32.2%) constitutive clindamycin resistance was higher among methicillin-resistant Staphylococcus aureus.
Conclusions:
The frequency of inducible clindamycin resistance among methicillin resistant Staphylococcus aureus was high, which alarms the use of macrolide-lincosamide-streptogramin B antibiotics in Staphylococcus aureus infections. Hence, D-test should be performed to detect inducible clindamycin resistance in routine testing to prevent treatment failure.
Insights
High rates of inducible clindamycin resistance in Staphylococcus aureus, particularly methicillin-resistant strains, were found. This highlights the urgent need for routine D-testing to guide antibiotic choices and prevent treatment failures.
Area of Science:
- Clinical microbiology
- Infectious diseases
- Antimicrobial resistance
Background:
- Staphylococcus aureus is a significant pathogen, with rising resistance to antibiotics.
- Macrolide-lincosamide-streptogramin B (MLSB) antibiotics are increasingly used but face emerging resistance.
- Inducible clindamycin resistance in S. aureus is a growing concern.
Purpose of the Study:
- To determine the prevalence of inducible clindamycin-resistant Staphylococcus aureus in a tertiary care center.
- To assess the co-resistance patterns in methicillin-resistant Staphylococcus aureus (MRSA).
Main Methods:
- A descriptive cross-sectional study of clinical isolates from September 2020 to May 2021.
- Antibiotic susceptibility testing using disc diffusion and D-test for inducible resistance.
- Cefoxitin disc used for methicillin resistance detection.
Main Results:
- Out of 141 S. aureus isolates, 29.1% exhibited inducible clindamycin resistance.
- Constitutive clindamycin resistance was observed in 21.3% of isolates.
- Inducible and constitutive resistance were higher in MRSA isolates (47.5% and 32.2%, respectively).
Conclusions:
- A high frequency of inducible clindamycin resistance in MRSA necessitates caution with MLSB antibiotic use.
- Routine D-testing is crucial for identifying inducible resistance and preventing treatment failure.
- This finding underscores the importance of antimicrobial stewardship programs.
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