G. Mahalakshmi, P. Neelusree, M. Kalyani
G. Mahalakshmi1, Dr. P. Neelusree2*, Dr. M. Kalyani3
1Principle, Investigator M.Sc., Medical Microbiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai - 602105.
2MD Associate Professor, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai - 602105.
3Head of the Department, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai - 602105.
Volume - 14,
Issue - 7,
Year - 2021
Background: Staphylococcus aureus is Gram positive cocci. The pyogenic bacteria which is responsible for a variety of diseases that ranges in severity from mild skin and soft tissue infections to life-threatening conditions such as endocarditis, pneumonia, and sepsis. There is a scenario of increasing Methicillin-resistant Staphylococcus aureus (MRSA) infections, the macrolide-lincosamide-streptogramin B (MLSB) group of antibiotics they have different structure with same mechanism of action which serves as one good alternative. There is a frequency of increasing Methicillin Resistant Staphylococcus aureus (MRSA) infections and their change in antimicrobial resistance pattern. There is a concern about use of this antibiotic in the presence of Erythromycin resistance because of the possibility of inducible resistance among the members of Macrolide, lincosamide, Strepto-gramin B (MLSB) group. The invitro resistance exhibited by Staphylococcus aureus to erythromycin, Clindamycin, and other drugs of MLSB groups is due to the expression of ribosomal methylases(erm) genes. The detection of inducible Clindamycin resistance can limit the effectiveness of these drugs. Objective of the study: To isolate of Staphylococcus aureus from various clinical samples to differentiate between Methicillin resistant Staphylococcus aureus (MRSA) and Methicillin sensitive Staphylococcus aureus (MSSA) by conventional methods. To detect inducible and constitutive Clindamycin resistance in Staphylococcus aureus isolates by D test. To detect ermA gene responsible for resistance by PCR. Methodology: This cross sectional study was done for a period of six months. Totally 106 Staphylococcus aureus isolates was obtained various clinical samples were processed using standard guidelines. Result: From the 106 isolates of Staphylococcus aureus 67(63.3%) were MSSA and 39(36.7%) were MRSA. D-test was positive in n=9 of the n=21 MRSA and n=17 of the n=85 MSSA, which denotes inducible Clindamycin resistance. N- 9 of MRSA and n=13(22%) of MSSA showed Constitutional Clindamycin resistance. The statistics show that there is a significant Difference in constitutive resistance between MRSA and MSSA. In India ermA gene is most prevalent, out of 22 d-test positive n=13 ermA gene were detected (n=3-MRSA and n=10-MSSA) by using conventional PCR. Conclusion: The MLSB family of antibiotics is one such alternative and CD is preferred. Clinical microbiology laboratories should report inducible Clindamycin resistance in Staphylococcus aureus and D-test can be used as a simple, auxiliary and reliable method to Delineate inducible and constitutive Clindamycin resistance in routine clinical laboratories.
Cite this article:
G. Mahalakshmi, P. Neelusree, M. Kalyani. Phenotypic characterization and Molecular detection of Inducible and Constitutive Clindamycin resistance among Staphylococcus aureus isolates in a Tertiary Care Hospital. Research Journal of Pharmacy and Technology. 2021; 14(7):3799-4. doi: 10.52711/0974-360X.2021.00658
G. Mahalakshmi, P. Neelusree, M. Kalyani. Phenotypic characterization and Molecular detection of Inducible and Constitutive Clindamycin resistance among Staphylococcus aureus isolates in a Tertiary Care Hospital. Research Journal of Pharmacy and Technology. 2021; 14(7):3799-4. doi: 10.52711/0974-360X.2021.00658 Available on: https://rjptonline.org/AbstractView.aspx?PID=2021-14-7-55
1. Arumugam Gnanamani, Periyasami Hariharan and Maneesh paul- Satyaseela-Staphylococcus aureus: Overview of Bacteriology, clinical diseases, Epidemiology, Antibiotic resistance and Therapeutic Approach. 2017; 10: 5772-67338
2. Majhi, S., Dash, M., Mohapatra, D., Mohapatra, A., and Chayani, N. (2016). Detection of inducible and constitutive clindamycin resistance among Staphylococcus aureus isolates in a tertiary care hospital, Eastern India. Avicenna Journal of Medicine, 2016; 6(3): 75-80.
3. Jadhav Savita Vivek, Gandham Nageswari Rajesh, Sharma Mukesh, Kaur Manpreet, Misra R.N. Matnani G.B., Ujagare M.T., B. Saikat, Kumar Ajay Biomedical Research- Prevalence of inducible Clindamycin resistance among community-and hospital-associated Staphylococcus aureus isolates in a tertiary care hospital in India. 2011; 22(4): 465-469
4. Smieja M. (1998). Current indications for the use of clindamycin: A critical review. The Canadian journal of infectious diseases = Journal canadien des maladies infectiousness, 9(1): 22-28. https:// doi.org/10.1155/1998/538090
5. CLSI, 2018. Methods for dilution of antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard 5th ed. CLSI document; 2018; M07-A8. (ISBN 1-56238-689-1).
6. Priyanka Kalbhor, Varsha Wanjare, Sunanda Shrikhande. Detection of inducible and constitutive clindamycin resistance among clinical isolates of Staphylococcus aureus in a tertiary care hospital. Indian Journal of Applied Research. 2018; 8(9); 2249-555
7. Mokta, K. K., Verma, S., Chauhan, D., Ganju, S. A., Singh, D., Kanga, A., Kumari, A., and Mehta, V. Inducible Clindamycin Resistance among Clinical Isolates of Staphylococcus aureus from Sub Himalayan Region of India. Journal of Clinical and Diagnostic Research: https://doi.org/10.7860/JCDR/2015/13846.6382
8. R. P. Adhikari, S. Shrestha, A. Barakoti and R. Amatya- Inducible clindamycin and methicillin resistant Staphylococcus aureus in a tertiary care hospital, Kathmandu, Nepal. Adhikari et al. BMC Infectious Diseases 2017; 17(1): 483
9. Lowy FD (1998). Staphylococcus aureus infections. N Engl J 1998; 339(8): 520-32.
10. Saffar H, Rajabiani A, Abdollahi A, Habibi S, Baseri Z. Frequency of inducible clindamycin resistance among gram-positive cocci in a tertiary hospital, Tehran, Iran. Iran J Microbiol 2016; 8(4): 243-48.
11. Duran, N., Ozer, B., Duran, G. G., Onlen, Y., and Demir, C. (2012). Antibiotic resistance genes and susceptibility patterns in staphylococci. The Indian Journal of Medical Research, 135(3): 389-396.
12. Shanthi M, Uma S. Antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus at Sri Ramachandra Medical Centre. Sri Ramachandra Journal of Medicine. 2009; 2(2): 1-4.
13. Deotale V, Mendiratta DK, Raut U, Narang P. Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Indian J Med Microbiol. 2010; 28: 12426.
14. Mokta KK, Verma S, Chauhan D, et al. Inducible Clindamycin Resistance among Clinical Isolates of Staphylococcus aureus from Sub Himalayan Region of India. J Clin Diagn Res. 2015; 9(8): DC20-DC23.
15. Duran N, Ozer V, Duran GG, Onlen Y, Demir C. Antibiotic resistance genes and susceptibility patterns in staphylococci. Indian J Med Res. 2012; 135(3): 389-96
16. Duran N, Ozer V, Duran GG, Onlen Y, Demir C. Antibiotic resistance genes and susceptibility patterns in staphylococci. Indian J Med Res. 2012; 135(3): 389-96
17. Gul, H. C., Kilic, A., Guclu, A. U., Bedir, O., Orhon, M., and Basustaoglu, A. C. (2008). Macrolide-lincosamide-streptogramin B resistant phenotypes and genotypes for methicillin-resistant Staphylococcus aureus in Turkey, from 2003 to 2006. Polish Journal of Microbiology, 57(4): 307-312.
18. Katherine S. Longa and Birte Vesterb Resistance to Linezolid Caused by Modifications at Its Binding Site on the Ribosome. Antimicrobial Agents Chemother. 2012; 56(2): 603-612.
19. Kavitha Prabhu, Sunil Rao, and Venkatakrishna Rao-Inducible Clindamycin Resistance in Staphylococcus aureus Isolated from Clinical Samples, J Lab Physicians. 2011; 3(1): 25-27.
20. Ciraj AM, Vinod P, Sreejith G, Rajani K. Inducible clindamycin resistance among clinical isolates of staphylococci. Indian J Pathol Microbiol. 2009; 52: 49-51
21. Vito G. Delvecchio, Joseph M. Petroziello, Michael J. Gress, Ferne K. Mccleskey, Gregory P. Melcher, Helen K. Crouch, and James R. Lupski4- Molecular Genotyping of Methicillin-Resistant Staphylococcus aureus via Fluorophore-Enhanced Repetitive-Sequence PCR Journal of Clinical Microbiology, 1995; 33(8): 2141-2144
22. Dr. Rajeev Saxena, Mohammad Mukhit Kazi, Mrs. Ashwini Bhosale, Ms. Sheeba Robert- Screening of Methicillin Resistant Staphylococcus Aureus In Patients Attending Dental Teaching Hospital. Z: 2013; 2(2): 54-56
23. Steward CD, Raney PM, Morrell AK, Williams PP, McDougal LK, Jevitt L, et al. Testing for induction of clindamycin resistance in erythromycin-resistant isolates of Staphylococcus aureus. J Clin Microbiol. 2005; 43(4): 1716-21
24. Perti p, Mazzei T, Mini E, Novelli A (1992): Pharmacokinetic drug interactions of macrolides. Clin Pharmacokinet 1992; 23(2): 106-31
25. Kloos WE, Musselwhite MS. Distribution and persistence of Staphylococcus and Micrococcus species and other aerobic bacteria on human skin. Appl Microbiol. 1975; 30(3): 381-385.
26. Levine M, Lexchin J, Pellizzari R, editors. Drugs of Choice A Formulary for General Practice. Ottawa: Canadian Medical Association; 1995.
27. Dong J, Qiu J, Wang J, Li H, Dai X, Zhang Y, et al. Apigenin alleviates the symptoms of Staphylococcus aureus pneumonia by inhibiting the production of alpha-hemolysin. FEMS Microbiol Lett. 2013; 338: 124-31.
28. Lertcanawanichakul M, Chawawisit K, Choopan A, Nakbud K, Dawveerakul K. Incidence of constitutive and inducible clindamycin resistance in clinical isolates of methicillin resistant Staphylococcus aureus. Walailak J Sci Technol. 2007; 4: 155-63.
29. Reddy M, Hima C, Bindu M, Soumendranath M, Kanta RC, Kapur I. Prevalence of inducible clindamycin resistance in Staphylococcus aureus from clinical samples: a study from a teaching hospital in Andhra Pradesh, India. Int J Curr Microbiol App Sci. 2014; 3: 40209.
30. Stanat, S.J., Carlton, C.G., Crumb, W.J. et al. Characterization of the inhibitory effects of erythromycin and clarithromycin on the HERG potassium channel. Mol Cell Biochem. 2003; 254: 1-7.