PREVALENCE OF INDUCIBLE CLINDAMYCIN RESISTANCE IN CLINICAL ISOLATES OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS MEDIATED THROUGH GENE ERMC EXPRESSION

Nimisha Tandon; Madhuri Kulkarni; Sowmya Gs; Fauzia Tabassum; Sayeed Akhtar Md

doi:10.22159/ajpcr.2018.v11i9.25928

Authors

Nimisha Tandon Department of Microbiology, JSS Medical college, Mysuru â€“ 570 015, Karnataka, India.
Madhuri Kulkarni Department of Microbiology, JSS Medical college, Mysuru â€“ 570 015, Karnataka, India.
Sowmya Gs Department of Microbiology, JSS Medical college, Mysuru â€“ 570 015, Karnataka, India.
Fauzia Tabassum Department of Pharmacology, All India Institute of Medical Sciences, Patna, Bihar, India.
Sayeed Akhtar Md Department of Clinical Pharmacy, College of Medicine and Health Sciences, Ambo University, Ambo-19, Ethiopia.

DOI:

https://doi.org/10.22159/ajpcr.2018.v11i9.25928

Keywords:

methicillin-resistant Staphylococcus aureus, Erm genes, D-test, Macrolide lincosamide streptograminB

Abstract

Objective: The objective of this study is to determine the phenotypic and genotypic expression of inducible clindamycin resistance due to the expression of ermA, ermB, and ermC genes in clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) by double disc diffusion and uniplex PCR.

Method: This cross-sectional study was conducted in microbiology department of an university teaching hospital. A total of 604 non-duplicate clinical isolates of S. aureus evaluated for MRSA and were subjected to uniplex PCR for ermA, ermB, and ermC genes, respectively.

Result: The analysis of 604 isolates showed that 220 (36.42%) were of MRSA. Out of which, 69 (11.42%) were demonstrated as inducible clindamycin resistance by double-disc diffusion method, and among inducible resistant isolates, 25 isolates of ermC (84%) were positive and 4 (16%) were negative, whereas, ermA and ermB genes could not be demonstrated by the genotypic method.

Conclusion: We observed that clindamycin may serve as a good alternative and advocated in severe MRSA infection based on susceptibility pattern. We observed D test as a mandatory method to detect inducible clindamycin Staphylococcus. Importantly, ermC gene is a major determinant of resistance to macrolides among MRSA.

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Author Biography

Nimisha Tandon, Department of Microbiology, JSS Medical college, Mysuru â€“ 570 015, Karnataka, India.

Assistant Professor, Clinical Pharmacy

References

Kapil A. Textbook of Microbiology. 9th ed. India: Universities Press; 2013.

Molton JS, Tambyah PA, Ang PS, Ling LM, Fisher AD. The global spread of healthcare-associated multidrug-resistant bacteria: A perspective from Asia. Clin Infect Dis 2013;56:1310-8.

Jindal N, Singh S, Grover P, Malhotra R. Prevalence of inducible clindamycin resistance among clinical isolates of MRSA in Malwa region of Punjab (North India), PARIPEX. Indian J Res 2013;10:133-4.

Joshi S, Ray P, Manchanda V, Bajaj J, Chitnis SD, Vikas G, et al. Methicillin resistant Staphylococcus aureus (MRSA) in India: Prevalence and susceptibility pattern. Indian J Med Res 2013;137:363 9.

Available from: http://www.who.int/gpsc/country_work/gpsc_ccisc_ fact_sheet_en.pdf. [Last accessed on 2017 Sep 25].

Kock R, Becker K, Cookson B, Van Gemert-Pijnen JE, Harbarth S, Kluytmans J, et al. Methicillin-resistant Staphylococcus aureus (MRSA): Burden of disease and control challenges in Europe. Eurosurveillance 2010;15:19688.

Filice AG, Nyman AJ, Lexau C, Lees HC, Bockstedt AL, Lindsay A, et al. Excess costs and utilization associated with methicillin resistance for patients with Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2010;31:365-73.

Ellingson K, Muder RR, Jain R, Kleinbaum D, Feng IJ, Cunningham C, et al. Sustained reduction in the clinical incidence of methicillin resistant staphylococcus aureus colonization or infection associated with a multifaceted infection control intervention. Infect Control Hosp Epidemiol 2011;32:1-8.

Albiger B, Griskeviciene J, Heuer O, Hogberg DL, Suetens C, et al. Annual Epidemiological Report, Reporting on 2011 Surveillance Data and 2012 Epidemic Intelligence Data; 2013. p. 199-205.

Gupta KY, Gupta G, Bishnoi RB, Binnani A, Garg PS. Phenotypic detection of inducible clindamycin resistance in Staphylococcus aureus. IJPRBS 2013;2:267-72.

Forrest GN, Oldach DW. Macrolides and clindamycin. In: Gorbach SL, Barlett JG, Blacklow NR, editors. Infectious Diseases. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2004. p. 223.

Zelazny MA, Ferraro JM, Glennen A, Hindler FJ, Mann ML, Munro S, et al. Selection of strains for quality assessment of the disk induction method for detection of inducible clindamycin resistance in staphylococci: A CLSI collaborative study. J Clin Microbiol 2005;43:2613-5.

Chelae S, Laohaprertthisarn V, Phengmak M, Kongmuang U, Kalnauwakul S. Detection of inducible clindamycin resistance in staphylococci by disk diffusion induction test. J Med Assoc Thai 2009;92:947-51.

Fiebelkorn KR, Crawford SA, McElmeel ML, Jorgensen JH. Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci. J Clin Microbiol 2003;41:4740-4.

Lina G, Quaglia A, Reverdy EM, Leclercq R, Vandenesch F, Etienne J. Distribution of genes encoding resistance to macrolides, lincosamides, and streptogramins among staphylococci. Antimicrob Agents Chemother 1999;43:1062-6.

Nashwa M, Al-Kasaby MN, El-Khier AT. Phenotypic and genotypic detection of MLSB resistance among clinical isolates of Staphylococcus aureus from Mansoura University: Children Hospital, Egypt. Afr J Microbiol Res 2017;11:488-94.

Divyashanthi CM, Adithiyakumar S, Bharathi N. Study of prevalence and antimicrobial susceptibility pattern of bacterial isolates in a tertiary care hospital. Int J Pharm Pharm Sci 2015;7:185-90.

Vanitha RN, Gopal K, Narendra MV, Vishwakanth D, Nagesh VR, Yogita M, et al. A retrospective study on blood stream infections and antibiotic susceptibility patterns in a tertiary care teaching hospital. Int J Pharm Pharm Sci 2012;4:543-8.

Fasih N, Irfan S, Zafar A, Khan E, Hasan R. Inducible clindamycin resistance due to expression of erm genes in Staphylococcus aureus. Report from a tertiary care hospital Karachi, Pakistan. J Pak Med Assoc 2010;60:750-3.

Anupurba S, Sen MR, Nath G, Sharma BM, Gulati AK, Mohapatra TM. Prevalence of methicillin resistant Staphylococcus aureus in a tertiary referral hospital in eastern Uttar Pradesh. Indian J Med Microbiol 2003;21:49-51.

Adam JH, Allen GV, Currie A, McGeer JA, Simor EA, Richardson ES, et al. Community-associated methicillin resistant Staphylococcus aureus: Prevalence in skin and soft tissue infections at emergency departments in the Greater Toronto Area and associated risk factors. CJEM 2009;11:439-46.

Valsesia G, Rossi M, Bertschy S, Pfyffer EG. Emergence of sccmec type IV and sccmec Type V Methicillin resistant Staphylococcus aureus containing the panton-valentine leukocidin genesina large academic teaching hospital in Central Switzerland: External invaders or persisting circulators? J Clin Microbiol 2010;48:720-7.

Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, et al. Methicillin resistant Staphylococcus aureus infections among patients in the emergency department. N Engl J Med 2006;355:666-74.

Spiliopoulou I, Petinaki E, Papandreou P, Dimitracopoulos G. erm(C) is the predominant genetic determinant for the expression of resistance to macrolide among methicillin resistance Staphylococcus aureus clinical isolates in Greece. J Antimicrob Chemother 2004;53:814-7.

Vidhya R, Parimala S, Beena PM. Inducible clindamycin resistance in Staphylococcus aureus isolates from a rural tertiary care hospital, Kolar. J Clin Biomed Sci 2013;3:125-8.

Upadhya A, Biradar S. Prevalence of inducible clindamycin resistance in Staphylococcus aureus in a tertiary care hospital in north-east Karnataka, India. Health Sci Int J 2011;1:21-4.

Adwan G, Adwan K, Jarrar N, Amleh A. Molecular detection of nine antibiotic resistance genes in methicillin resistant Staphylococcus aureus isolates. Roum Arch Microbiol Immunol 2014;73:9-17.