Macrolide-lincosamide-streptogramin B Resistance Phenotypes in Staphylococcus aureus

Abstract

Staphylococcus aureus is one of the most frequently isolated pathogens in community and hospital-acquired infections. Macrolide-lincosamide-streptogramin B (MLSB) group antibiotics have frequently been preferred. In this study, it was aimed to determine MLSB group antibiotics resistance phenotypes observed in S. aureus strains. A total of 182 S. aureus strains were included in the study. Methicillin resistance was assessed using the cefoxitin (30μg) disc, MLSB resistance phenotypes were assessed using D zone test with erythromycin (15μg) and clindamycin (2μg) discs according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. Of the strains included in the study, 38 (20.9%) methicillin-resistant S.aureus (MRSA) and 144 (79.1%) methicillin-susceptible S.aureus (MSSA) were identified. MLSB resistance phenotype was found in 65 (35.7%) strains. MLSB resistance was found 84% in MRSA strains and 23% in MSSA strains: There was statistically significant between MRSA and MSSA strains. Constitutional MLSB resistance was found higher in MRSA strains (71%) and however, in MSSA strains was higher inducibleMLSB resistance (16.5%). It is suggested that, using the D test method in routine antibiotic susceptibility testing and determining resistance phenotypes in microbiology laboratories is the right approach and may play an important role in the prevention of treatment failure according to the substantial proportion of inducible resistance MLSB resistance observed.

Keywords

• Staphylococcus aureus, MLSB resistance, D test, methicillin resistance

Macrolide-lincosamide-streptogramin B Resistance Phenotypes in Staphylococcus aureus

Abstract

Staphylococcus aureus toplum ve hastane kaynaklı infeksiyonlarda en sık izole edilen etkenlerdendir. Makrolid-linkozamidstreptogramin B (MLSB) grubu antibiyotikler sıklıkla tercih edilmektedir. Bu çalışmada MLSB grubu antibiyotiklere S. aureus suşlarında görülen direnç fenotiplerinin belirlenmesi amaçlanmıştır. Çalışmaya toplam 182 S. aureus suşu dahil edildi. Suşların metisilin direnci sefoksitin (30µg) diski kullanılarak, MLSB direnç fenotipleri disk yakınlaştırma yöntemi ile eritromisin (15µg) ve klindamisin (2µg) diskleri kullanılarak Clinical and Laboratory Standards Institute (CLSI) önerileri doğrultusunda değerlendirildi. Çalışmaya alınan suşların 38’i (%20.9) metisiline dirençli S. aureus (MRSA), 144’ü (%79.1) metisiline duyarlı S. aureus (MSSA) olarak tespit edilmiştir. Tüm suşların 65’inde (%35.7) MLSB direnci bulunmuştur. MRSA suşlarında MLSB direnci % 84 iken, MSSA suşlarında %23 olarak tespit edilmiş ve bu değerler istatistiksel olarak anlamlı bulunmuştur. MRSA suşlarında yapısal MLSB (%71), MSSA suşlarında ise indüklenebilir MLSB(%16.5)direnci daha fazla bulunmuştur. İndüklenebilir MLSB direncinin azımsanmayacak oranlarda görülmesi nedeni ile mikrobiyoloji laboratuvarlarında D test yönteminin rutin olarak antibiyotik duyarlılık testlerinde kullanılması ve direnç fenotiplerinin belirlenmesinin tedavi başarısızlıklarını önlemede önemli ve doğru bir yaklaşım olduğunu düşündürmüştür

Keywords

• Staphylococcus aureus, MLSB direnci, D test, metisilin direnci

References

1. Cercenado E, Ruiz de Gopegui E. Community-acquired methicillin-resistant Staphylococcus aureus. Enferm Infecc Microbiol Clin 2008;26 Suppl 13:19-24.
2. Cetin ES, Gunes H, Kaya S, Aridogan BC, Demirci M. Macrolide-lincosamide-streptogramin B resistance pheno- types in clinical staphylococcal isolates. Int J Antimicrob Agents 2008;31:364-8.
3. Wondrack L, Massa M, Yang BV, Sutcliffe J. Clinical strain of Staphylococcus aureus inactivates and causes efflux of macrolides. Antimicrob Agents Chemother 1996;40:992-8.
4. Prunier AL, Malbruny B, Tande D, Picard B, Leclercq R. Clinical isolates of Staphylococcus aureus with ribo- somal mutations conferring resistance to macrolides. Antimicrob Agents Chemother 2002;46:3054-6.
5. Roberts MC, Sutcliffe J, Courvalin P, Jensen LB, Rood J, Seppala H. Nomenclature for macrolide and macrolide- lincosamide-streptogramin B resistance determinants. Antimicrob Agents Chemother 1999;43:2823-30.
6. Lewis JS, Jorgensen JH. Inducible clindamycin resistance in Staphylococci: should clinicians and microbiologists be concerned? Clin Infect Dis 2005;40:280-5.
7. Steward CD, Raney PM, Morrell AK, et al. Testing for in- duction of clindamycin resistance in erythromycin-resis- tant isolates of Staphylococcus aureus. J Clin Microbiol 2005;43:1716-21.
8. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. M100-S18, 2008. CLSI, Wayne, PA.

9. Chavez-Bueno S, Bozdogan B, Katz K, et al. Inducible clindamycin resistance and molecular epidemiologic trends of pediatric community-acquired methicillin-resis- tant Staphylococcus aureus in Dallas, Texas. Antimicrob Agents Chemother 2005;49:2283-8.
10. Fiebelkorn KR, Crawford SA, McElmeel ML, Jorgensen JH. Practical disk diffusion method for detection of in- ducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci. J Clin Microbiol 2003;41:4740-4.
11. Patel M, Waites KB, Moser SA, Cloud GA, Hoesley CJ. Prevalence of inducible clindamycin resistance among community- and hospital-associated Staphylococcus au- reus isolates.J Clin Microbiol Jul 2006;44:2481-4.
12. Maravic G. Macrolide resistance based on the Erm- mediated rRNA methylation. Curr Drug Targets Infect Disord 2004;4:193-202.
13. Schmitz FJ, Sadurski R, Kray A, et al. Prevalence of macrolide-resistance genes in Staphylococcus aureus and Enterococcus faecium isolates from 24 European universi- ty hospitals. J Antimicrob Chemother Jun 2000;45:891-4.
14. Lina G, Quaglia A, Reverdy ME, Leclercq R, Vandenesch F, Etienne J. Distribution of genes encoding resis- tance to macrolides, lincosamides, and streptogramins among staphylococci. Antimicrob Agents Chemother 1999;43:1062-6.
15. Fokas S, Fokas S, Tsironi M, Kalkani M, Dionysopouloy M. Prevalence of inducible clindamycin resistance in macro- lide-resistant Staphylococcus spp. Clin Microbiol Infect 2005;11:337-40.
16. Otsuka T, Zaraket H, Takano T, et al. Macrolide- lincosamide-streptogramin B resistance phenotypes and genotypes among Staphylococcus aureus clinical isolates in Japan. Clin Microbiol Infect 2007;13:325-7.
17. Lim HS, Lee H, Roh KH, et al. Prevalence of inducible clindamycin resistance in staphylococcal isolates at a Korean tertiary care hospital. Yonsei Med J 2006;47:480- 4.
18. Gadepalli R, Dhawan B, Mohanty S, Kapil A, Das BK, Chaudhry R. Inducible clindamycin resistance in clini- cal isolates of Staphylococcus aureus. Indian J Med Res 2006;123:571-3.
19. Aktas Z, Aridogan A, Kayacan CB, Aydin D. Resistance to macrolide, lincosamide and streptogramin antibiotics in Staphylococci isolated in Istanbul, Turkey. J Microbiol 2007;45:286-90.
20. Uyanik MH, Yazgi H, Bilici D, Ozden K, Karakoc E. Detection of macrolide-lincosamide-streptogramin B resistance in nosocomial Staphylococcus aureus strains. ANKEM Derg 2009;23:66-70.
21. Delialioglu N, Aslan G, Ozturk C, Baki V, Sen S, Emekdas G. Inducible clindamycin resistance in staphylococci isolated from clinical samples. Jpn J Infect Dis 2005;58(2):104-6.
22. Saribas Z, Tunckanat F, Ozcakir O, Ercis S. Investigation of Macrolide-Lincosamide-Streptogramin B (Mlsb) and Telithromycin Resistance in Clinical Strains of Staphylococci. Mikrobiyoloji bulteni 2010;44(2):177-86.