PHENOTYPIC DETERMINATION OF INDUCIBLE CLINDAMYCIN RESISTANT AND METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS FROM CLINICAL ISOLATES OF KHYBER TEACHING HOSPITAL, PESHAWAR

M HAMID; K BASHIR; M RIZWAN; FEA KHILGEE; M AAMIR; K KHAYAM

doi:10.54112/bbasr.v2023i1.41

Authors

M HAMID Faculty of Life Sciences, Department of Microbiology and Biotechnology, Abasyn University Peshawar, Pakistan
K BASHIR Faculty of Life Sciences, Department of Microbiology and Biotechnology, Abasyn University Peshawar, Pakistan
M RIZWAN Department of Microbiology and Biotechnology, University of Swat, Pakistan
FEA KHILGEE ARTS Programm Universität Bonn, Germany
M AAMIR Surgical Ward, Khyber Teaching Hospital Peshawar, Khyber Pakhtonkhwa, Pakistan
K KHAYAM Combined Military Hospital, Peshawar, Pakistan

DOI:

https://doi.org/10.54112/bbasr.v2023i1.41

Keywords:

Methicillin Resistant Staphylococcus aureus (MRSA), Inducible Clindamycin Resistance (iCR), Double disk diffusion (D-test)

Abstract

Methicillin Resistant Staphylococcus aureus (MRSA) is a major pathogen involved in nosocomial infections and to some extent, in community acquired infections. Among Macrolide Lincosamine Streptogramin B (MLSB) class of drugs, Clindamycin was vigorously preferred for treating staphylococcal infections in the past few decades but, some genetic factors i.e. erm and msrA genes contribute in developing Inducible Clindamycin Resistance (iCR). Sensitivity tests performed on a routine basis cannot detect inducible resistance and may result in the failure of Clindamycin to be used as an effective medication. This study aimed to detect the phenotype of MRSA and iCR S. aureus from the clinical samples of Khyber Teaching Hospital, Peshawar. A total of 204 samples were collected randomly from each gender, 130 (63.72%) samples were isolated as S. aureus, while 74 (36.27%) were other bacterial species. Double disk diffusion (D-test) was performed to detect iCR phenotype, and 80 (61.5%) isolates showed iCR, while 50 (38.4%) were negative in this regard. MRSA phenotype was determined by strains conferring resistance to Cefoxitin antibiotic, which resulted in 84 (64.6%) isolates of MRSA and 46 (35.3%) of Methicillin Sensitive Staphylococcus aureus (MSSA). Antibiogram analysis showed efficient antimicrobial activity by Tigecycline 129 (99.2%), Fusidic Acid 126 (96.9%), and Doxycycline 124 (95.3%), while the highest resistance pattern was recorded against Ciprofloxacin 31(23.8%) and Clindamycin 28(21.5%). Our study concludes that misuse of antibiotics should be avoided to inhibit the spread of MRSA, and implementation of D-test regularly in hospitals is crucial.

References

Adhikari, R., Shrestha, S., Barakoti, A., and Amatya, R. (2017). Inducible clindamycin and methicillin resistant Staphylococcus aureus in a tertiary care hospital, Kathmandu, Nepal. BMC infectious diseases 17, 1-5. https://doi.org/10.1186/s12879-017-2584-5 DOI: https://doi.org/10.1186/s12879-017-2584-5

Aktas, Z., Aridogan, A., Kayacan, C. B., and Aydin, D. (2007). Resistance to macrolide, lincosamide and streptogramin antibiotics in staphylococci isolated in Istanbul, Turkey. The Journal of Microbiology 45, 286-290.

Elkammoshi, A. M., Ghasemzadeh-Moghaddam, H., Nordin, S. A., Taib, N. M., Subbiah, S. K., Neela, V., and Hamat, R. A. (2016). A low prevalence of inducible macrolide, lincosamide, and streptogramin b resistance phenotype among methicillin-susceptible Staphylococcus aureus isolated from malaysian patients and healthy individuals. Jundishapur journal of microbiology 9. https://doi.org/10.5812/jjm.37148 DOI: https://doi.org/10.5812/jjm.37148

Fiebelkorn, K., Crawford, S., McElmeel, M., and Jorgensen, J. (2003). Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci. Journal of clinical microbiology 41, 4740-4744. https://doi.org/10.1128/JCM.41.10.4740-4744.2003. DOI: https://doi.org/10.1128/JCM.41.10.4740-4744.2003

Fokas, S., Fokas, S., Tsironi, M., Kalkani, M., and Dionysopouloy, M. (2005). Prevalence of inducible clindamycin resistance in macrolide‐resistant Staphylococcus spp. Clinical microbiology and infection 11, 337-340. https://doi.org/10.1111/j.1469-0691.2005.01101.x DOI: https://doi.org/10.1111/j.1469-0691.2005.01101.x

Frazee, B. W., Lynn, J., Charlebois, E. D., Lambert, L., Lowery, D., and Perdreau-Remington, F. (2005). High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Annals of emergency medicine 45, 311-320. https://doi.org/10.1016/j.annemergmed.2004.10.011 DOI: https://doi.org/10.1016/j.annemergmed.2004.10.011

Gharib, A., Attia, A., and Bendary, M. (2013). Detection of the coa gene in Staphylococcus aureus from different sources by polymerase chain reaction. Suez Canal Veterinary Medical Journal. SCVMJ 18, 167-177. https://doi.org/10.21608/SCVMJ.2013.78290 DOI: https://doi.org/10.21608/scvmj.2013.78290

Ghosh, S., and Banerjee, M. (2016). Methicillin resistance & inducible clindamycin resistance in Staphylococcus aureus. The Indian journal of medical research 143, 362. https://doi.org/10.4103/0971-5916.182628 DOI: https://doi.org/10.4103/0971-5916.182628

Goldman, R., and Capobianco, J. (1990). Role of an energy-dependent efflux pump in plasmid pNE24-mediated resistance to 14-and 15-membered macrolides in Staphylococcus epidermidis. Antimicrobial agents and chemotherapy 34, 1973-1980. https://doi.org/10.1128/aac.34.10.1973 DOI: https://doi.org/10.1128/AAC.34.10.1973

Kale, S. S., and Patil, A. (2019). The study of reduced susceptibility of methicillin resistant Staphylococcus aureus to various antibiotics with special reference to glycopeptides in a tertiary care hospital in central India. International Journal Of Community Medicine And Public Health, 6(4), 1426–1433. https://doi.org/10.18203/2394-6040.ijcmph20191132 DOI: https://doi.org/10.18203/2394-6040.ijcmph20191132

Kaleem, F., Usman, J., Hassan, A., Omair, M., Khalid, A., and Uddin, R. (2010). Sensitivity pattern of methicillin resistant Staphylococcus aureus isolated from patients admitted in a tertiary care hospital of Pakistan. Iranian journal of microbiology 2, 143.

Kilany, A. A. (2016). Inducible clindamycin resistance among clinical isolates of Staphylococcus aureus. Menoufia Medical Journal 29, 228. https://doi.org/10.4103/1110-2098.192418 DOI: https://doi.org/10.4103/1110-2098.192418

Lall, M., and Sahni, A. (2014). Prevalence of inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Medical Journal Armed Forces India 70, 43-47. https://doi.org/10.1016/j.mjafi.2013.01.004 DOI: https://doi.org/10.1016/j.mjafi.2013.01.004

Marais, E., Aithma, N., Perovic, O., Oosthuysen, W., Musenge, E., and Dusé, A. (2009). Antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus isolates from South Africa. South African medical journal 99, 170-173.

Patel, M., Waites, K. B., Moser, S. A., Cloud, G. A., and Hoesley, C. J. (2006). Prevalence of inducible clindamycin resistance among community-and hospital-associated Staphylococcus aureus isolates. Journal of clinical microbiology 44, 2481-2484. https://doi.org/10.1128/JCM.02582-05 DOI: https://doi.org/10.1128/JCM.02582-05

Prabhu, K., Rao, S., and Rao, V. (2011). Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Journal of laboratory physicians 3, 025-027. https://doi.org/10.4103/0974-2727.78558. DOI: https://doi.org/10.4103/0974-2727.78558

Yadav, K., Singh, G., Bhattacharjee, S., and Shrestha, K. Study of Extended Spectrum Beta-Lactamases Producing. Escherichia coli, 31-36.