|Year : 2017 | Volume
| Issue : 4 | Page : 314-316
High prevalence of clindamycin resistance in Staphylococcus aureus blood culture isolates in São Paulo, Brazil
Felipe S Lupinacci, Daniel Bussius, Felipe Acquesta, Gustavo Fam, Raphael Rossi, Alessandra Navarini, Marcelo J Mimica
Department of Pathology, Division of Microbiology, School of Medicine, Santa Casa de São Paulo, São Paulo, Brazil
|Date of Submission||29-Nov-2016|
|Date of Acceptance||21-Mar-2017|
|Date of Web Publication||11-Sep-2017|
Marcelo J Mimica
Departamento de Ciências Patológicas, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Disciplina de Microbiologia, Rua Cesário Motta Júnior, 112, São Paulo
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Clindamycin has become an important antimicrobial option for the treatment of Staphylococcus aureus. However, little is known about the current patterns of clindamycin-susceptibility in S. aureus invasive isolates, both in our country and in other developing countries in the world.
Aims: The aim of this study was to determine the prevalence of constitutive and inducible clindamycin resistance in methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) blood culture isolates in São Paulo, Brazil.
Materials and Methods: From July 2011 to June 2012, all S. aureus isolates from blood cultures collected at our hospital were included in the study. Antimicrobial susceptibility testing was performed according to recommendations of the Clinical and Laboratory Standards Institute.
Results: Total prevalence of clindamycin resistance was 68%, including 7.2% with inducible resistance. In MRSA resistance rate was 90.8% whereas in MSSA the rate was 32.7%.
Conclusions: Our high prevalence of clindamycin resistance highlights the importance of performing D-test in a routine base, as well of maintaining continued surveillance for the prevalence of clindamycin resistance.
Keywords: Clindamycin, methicillin resistant Staphylococcus aureus, Staphylococcus aureus
|How to cite this article:|
Lupinacci FS, Bussius D, Acquesta F, Fam G, Rossi R, Navarini A, Mimica MJ. High prevalence of clindamycin resistance in Staphylococcus aureus blood culture isolates in São Paulo, Brazil. J Lab Physicians 2017;9:314-6
|How to cite this URL:|
Lupinacci FS, Bussius D, Acquesta F, Fam G, Rossi R, Navarini A, Mimica MJ. High prevalence of clindamycin resistance in Staphylococcus aureus blood culture isolates in São Paulo, Brazil. J Lab Physicians [serial online] 2017 [cited 2019 Mar 19];9:314-6. Available from: http://www.jlponline.org/text.asp?2017/9/4/314/214260
| Introduction|| |
Staphylococcus aureus is a major cause of community- and health-care associated infections worldwide. In the last decades, treatment of such infections has been complicated by escalating antimicrobial resistance. Penicillin- and methicillin-resistant strains have disseminated globally and more recently, community-associated methicillin- resistant S. aureus (CA-MRSA) as well vancomycin-intermediate, and vancomycin-resistant S. aureus isolates have been described and are also disseminating.,,
Clindamycin has become an important antimicrobial option for the treatment of both methicillin-susceptible S. aureus (MSSA) and MRSA, mainly CA S. aureus infections., However, little is known about the current patterns of clindamycin-susceptibility in S. aureus invasive isolates, both in our country and in other developing countries in the world.
Resistance to clindamycin in S. aureus derives from target site modification, mediated by erm genes, which lead to ribosomal methylation. Resistance may occur either in an inducible or constitutive form.
The aim of this study was to determine the prevalence of constitutive and inducible clindamycin resistance in MSSA, and MRSA blood culture isolates in São Paulo, Brazil.
| Materials and Methods|| |
From July 2011 to June 2012, all S. aureus isolates from blood cultures collected at our hospital were included in the study. Our hospital is a quaternary care general hospital in São Paulo, Brazil. Isolates were identified using traditional microbiology methods, including Gram stain, catalase, coagulase, and DNAse.
Antimicrobial susceptibility testing was performed according to recommendations of the Clinical and Laboratory Standards Institute (CLSI). D-test was performed to detect inducible clindamycin resistance, also following recommendations issued by the CLSI.
S. aureus isolates from blood cultures of patients that already had an isolate included in the study were excluded. Thus, only one (the first) isolate per patient was included in the study.
| Results|| |
During the study, we included 125 isolates. Seventy-six (60.8%) were MRSA and 49 (39.2%) were MSSA. Total prevalence of clindamycin resistance was 68% (85/125), including 76 (60.8%) with constitutive resistance and 9 (7.2%) with inducible resistance. Regarding the MRSA, one of the 76 isolates had inducible clindamycin resistance, and 68 had constitutive resistance. Only 7 (9.2%) MRSA were clindamycin susceptible. Of the 49 MSSA, 16 were resistant to clindamycin, including eight with inducible resistance and eight with constitutive resistance. Thirty-three (67.3%) were clindamycin susceptible.
| Discussion|| |
Although inducible clindamycin resistance was present in only nine isolates, this finding highlights the paramount importance of the routine use by D-test by clinical microbiology laboratories, since the resistance in these isolates would not be detected without this specific method. D-test is recommended routinely both by the CLSI and by the European Committee on Antimicrobial Susceptibility Testing., However, even in developing countries, only a fraction of clinical laboratories follow such recommendations.
The high prevalence of clindamycin resistance may impact empirical therapy in the era of dissemination of CA-MRSA since clindamycin is now used globally as empirical treatment for possible S. aureus infections where CA-MRSA is common., Others have also reported elevated rates of clindamycin resistance in S. aureus.,, Glycopeptides, trimethoprim-sulfamethoxazole and a number of new antimicrobial agents are being used in such cases, but their use is sometimes problematic, due to resistance or limited scientific evidence supporting it. In addition, clindamycin is an important part of antimicrobial therapy for cases of toxic shock syndrome. Linezolid has recently also been showed to reduce toxic shock syndrome toxin-1 production and could be an option in these cases. However, its costs and availability are still a concern.
Continued surveillance for the presence of clindamycin resistance is paramount to ensure adequate empirical antimicrobial therapy. Appropriate in vitro antimicrobial susceptibility tests, including D-test, are important not only as part of surveillance efforts but also to guarantee correct specific treatment for individual patients with staphylococcal infections.
| Conclusions|| |
Our high prevalence of clindamycin resistance highlights the importance of performing D-test in a routine base, as well of maintaining continued surveillance for the prevalence of clindamycin resistance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mimica MJ, Berezin EN, Carvalho RB. Healthcare associated PVL negative methicillin-resistant Staphylococcus aureus
with SCCmec type IV. Pediatr Infect Dis J 2009;28:934.
Mimica MJ, Berezin EN, Damaceno N, Carvalho RB. SCCmec type IV, PVL-negative, methicillin-resistant Staphylococcus aureus
in cystic fibrosis patients from Brazil. Curr Microbiol 2011;62:388-90.
Tarai B, Das P, Kumar D. Recurrent challenges for clinicians: Emergence of methicillin-resistant Staphylococcus aureus
, vancomycin resistance, and current treatment options. J Lab Physicians 2013;5:71-8.
] [Full text]
Cadena J, Sreeramoju P, Nair S, Henao-Martinez A, Jorgensen J, Patterson JE. Clindamycin-resistant methicillin-resistant Staphylococcus aureus
: Epidemiologic and molecular characteristics and associated clinical factors. Diagn Microbiol Infect Dis 2012;74:16-21.
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Twenty-Third Informational Supplement, M100-S23. Wayne, PA: EUA, Clinical and Laboratory Standards Institute; 2013.
Patra KP, Vanchiere JA, Bocchini JA Jr. Adherence to CLSI recommendations for testing of Staphylococcus aureus
isolates in Louisiana hospitals: Report of a clinical failure and results of a questionnaire study. J Clin Microbiol 2011;49:3019-20.
Changchien CH, Chen SW, Chen YY, Chu C. Antibiotic susceptibility and genomic variations in Staphylococcus aureus
associated with Skin and Soft Tissue Infection (SSTI) disease groups. BMC Infect Dis 2016;16:276.
Ghaznavi-Rad E, Neela V, Nor Shamsudin M, Ghasemzadeh Moghaddam H, Tavakol M, van Belkum A, et al
. Diversity in the antimicrobial susceptibility patterns of methicillin-resistant Staphylococcus aureus
clones. Eur J Clin Microbiol Infect Dis 2012;31:3317-21.
McDougal LK, Fosheim GE, Nicholson A, Bulens SN, Limbago BM, Shearer JE, et al
. Emergence of resistance among USA300 methicillin-resistant Staphylococcus aureus
isolates causing invasive disease in the United States. Antimicrob Agents Chemother 2010;54:3804-11.
Stevens DL, Ma Y, Salmi DB, McIndoo E, Wallace RJ, Bryant AE. Impact of antibiotics on expression of virulence-associated exotoxin genes in methicillin-sensitive and methicillin-resistant Staphylococcus aureus
. J Infect Dis 2007;195:202-11.