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Inducible Clindamycin-Resistant Staphylococcus aureus Strains in Africa: A Systematic Review
1Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
Introduction:
Excessive use of clindamycin enhances the acquisition of inducible clindamycin-resistant S. aureus strains, which is a significant health problem in Africa. The main objective of this review study was to determine the prevalence of inducible clindamycin resistance and related genes among S. aureus isolates in Africa.
Methods:
A qualitative systematic review was conducted on inducible clindamycin resistance among S. aureus isolates in Africa using electronic databases such as Google Scholar and PubMed. Articles published in English before 2021 were selected, and relevant data were extracted, collected, and analyzed.
Results:
In our search, 22 articles met the eligibility criteria for this review study. Of 3064 total S. aureus isolates, 605 had iMLSB phenotype. The overall prevalence of inducible clindamycin resistance in S. aureus isolates was 19.8% with a range of 2.9% to 44.0%. A high number of iMLSB phenotypes were observed in MRSA isolates (3.6-77.8%) than MSSA (0-58.8%). The overall prevalence of the iMLSB phenotype in MRSA strains was 26.8% (279/1041). The maximum peak prevalence of inducible clindamycin resistance among S. aureus isolates recorded in the continent was 44.0% in Egypt, followed by 35.8% in Libya and 33.3% in Uganda in 2017, 2007, and 2013, respectively. The highest prevalence of iMLSB phenotype in MRSA strains was reported in Egypt, 77.8%, followed by Nigeria, 75.0%, and Libya, 66.2%. Among the recovered drug-resistance genes, ermA, ermC, and msrA genes were commonly detected in Egypt with 67.9%, 70.0%, and 70.0% prevalence, respectively.
Conclusion:
This review highlights a higher inducible resistance of S. aureus, including MRSA strains to clindamycin in the continent. Regular screening of these strains, wise use of clindamycin, and molecular detection and genotyping of resistant genes are urgent.
Insights
Inducible clindamycin resistance in Staphylococcus aureus is a growing concern in Africa, affecting nearly 20% of isolates. This resistance is particularly high in MRSA strains, necessitating urgent screening and judicious antibiotic use.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Clindamycin resistance in Staphylococcus aureus is a significant public health issue in Africa.
- The increasing prevalence of inducible clindamycin resistance (iMLSB) in S. aureus strains poses a therapeutic challenge.
Purpose of the Study:
- To determine the prevalence of inducible clindamycin resistance in S. aureus isolates across Africa.
- To identify the common resistance genes associated with inducible clindamycin resistance in S. aureus.
Main Methods:
- A systematic review of qualitative studies was conducted.
- Electronic databases (PubMed, Google Scholar) were searched for relevant articles published before 2021.
- Data from 22 eligible studies, encompassing 3064 S. aureus isolates, were extracted and analyzed.
Main Results:
- The overall prevalence of inducible clindamycin resistance in S. aureus was 19.8%.
- Inducible clindamycin resistance was more common in Methicillin-resistant Staphylococcus aureus (MRSA) strains (26.8%) compared to Methicillin-susceptible Staphylococcus aureus (MSSA) strains.
- Prevalence varied significantly by country, with Egypt, Libya, and Uganda reporting high rates. Common resistance genes identified include ermA, ermC, and msrA.
Conclusions:
- Africa exhibits a high prevalence of inducible clindamycin resistance in S. aureus, including MRSA.
- Urgent measures are needed, including regular screening, rational clindamycin use, and molecular characterization of resistance genes.
