Inducible-Clindamycin Resistance in <i>Staphylococcus aureus </i> Isolates in Rivers State, Nigeria

Easter Godwin Nwokah; Samuel Douglas Abbey

doi:doi:10.11648/j.ajcem.20160403.13

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Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria

Easter Godwin Nwokah, Samuel Douglas Abbey

Published in American Journal of Clinical and Experimental Medicine (Volume 4, Issue 3)

Received: 20 March 2016 Accepted: 30 March 2016 Published: 11 May 2016

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Abstract

Clindamycin is indicated in the treatment of skin and soft-tissue infections caused by Staphylococcal species. Treatment of an infection caused by a strain carrying inducible erm gene using clindamycin or any non-inducer macrolide can lead to clinical failure. The present study was aimed to detect inducible-clindamycin resistance (MLS_Bi) among S. aureus isolates in Port Harcourt, Nigeriaand to study the relationship between clindamycin and methicillin-resistant (MRSA).Two hundred and five (205) non-duplicate Staphylococcus aureus previously isolated from human sources were randomly collected from three health facilities- University of Port Harcourt Teaching Hospital, Braithwaite Memorial Specialist Hospital and De-Integrated Laboratories-all located in Port Harcourt, Nigeria, for this study from August, 2012 to July, 2013. Isolates were grouped as hospital in-patient (termed hospital- acquired – Nosocomial; n = 76) and out- patient cases (community-acquired; n = 129) Staphylococcus aureus . The isolates collected were reconfirmed following standard laboratory protocols. All confirmed isolates were stored in glycerol at +4°C (later sub-cultured for various phenotypic analyses). Using the disk diffusion method, detection of MRSA was carried out with 1μg of oxacillin (OXOID) placed on Mueller-Hinton agar with 4% NaCl supplementation).Antimicrobial susceptibility testing was performed using Erythromycin (15μg) and Clindamycin (2μg) both obtained from OXOID, UK. All clindamycin-sensitive isolates that were also erythromycin-resistant were subjected to D-Test phenotype (Inducible-clindamycin resistance). Among the 205 S. aureus isolates studied, Forty-four (21.5%) showed resistance to erythromycin, while 38 of these erythromycin-resistant isolates were simultaneously sensitive to clindamycin. Overall, out of 205 isolates, inducible-clindamycin resistance was detected in 23 (11.2%) of the isolates. These 23 (inducible MLSB phenotype) are among 38 erythromycin-resistant S. aureus that were simultaneously sensitive (phenotypically) to clindamycin. Ten (4.9%) of the total (205) study isolates expressed constitutive resistance to clindamycin. Oxacillin Resistance (MRSA) was detected in 25 (12.2%) of the 205 isolates. Among the 38 erythromycin-resistant S. aureus, four were MRSA while 3 (75%) of the 4 erythromycin-resistant MRSA expressed inducible resistance to clindamycin. 20 (58.8%) of 34 erythromycin-resistant MSSA expressed inducible resistance to clindamycin. MRSA phenotype was not significantly correlated (p=0.9430) to inducible-clindamycin resistance. Inducible clindamycin-resistance often leads to treatment failure. The clinical microbiology laboratories in Nigeria should consider routine testing and reporting of inducible clindamycin resistance in S. aureus . There is also the need for sustained surveillance of antimicrobial susceptibilities of S. aureus in this region.

Published in American Journal of Clinical and Experimental Medicine (Volume 4, Issue 3)

DOI 10.11648/j.ajcem.20160403.13

Page(s) 50-55

Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

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Copyright © The Author(s), 2016. Published by Science Publishing Group

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Keywords

Staphylococcus aureus , MRSA, Erythromycin- Resistance, Inducible-Clindamycin Resistance

References

[1] Shittu, A. O., Lin, J. and Kolawole, D. O. (2006). Antimicrobial susceptibility patterns of Staphylococcus aureus and characterization of MRSA in Southwestern Nigeria. Wounds, 18, 77-84.

[2] Shittu, A., Oyedara, O., Abegunrin, F. Okon, K. Raji, A. Taiwo, S. Ogunsola, F., Onyedibe, K. and Elisha, G. (2012). Characterization of methicillin-susceptible and -resistant staphylococci in the clinical setting: a multicentre study in Nigeria. Biomed Central Infectious Diseases, 12, 286-295.

[3] Nwokah, E. G. Obunge, O. K, Ayodele, M. B. O., Abbey, S. D. and Tatfeng, Y. M. (2012). Nasal Carriage of Staphylococcus aureus and MRSA among Food Handlers in a Sub-Urban Setting in Rivers State, Nigeria. Nigerian Biomedical Science Journal, 8 (3), 58-61.

[4] Okwu, M. U., Okorie, T. G., Mitsan, O. and Osakue, E. O. (2014). Prevalence and comparison of three methods for detection of methicillin-resistant Staphylococcus aureus (MRSA) isolates in tertiary health institutions in Nigeria. Canadian Open Biological Sciences Journal, 1 (1), 1–12.

[5] Delialioglu N, Aslan G, Ozturk C, Baki V, Sen S, and Emekdas G. (2005). Inducible clindamycin resistance in staphylococci isolated from clinical samples. Japan Journal ofInfectious Disease, 58, 104–106.

[6] Deotale V, Mendiratta DK, Raut U, and Narang P (2010). Inducible clindamycin resistance in Staphylococcus aureusisolated from clinical samples. Indian Journal Medical Microbiology, 28,124–126.

[7] Leclercq R., R. B. Giannattasio, H. J. Jin, and B. Weisblum (1991). Bacterial resistance to macrolide, lincosamide and streptogramin antibiotics by target modification. Antimicrobial Agents Chemotherapy, 35,1267-1272.

[8] Weisblum B (1999) Resistance to macrolide-lincosamide-streptogramin antibiotics, p. 682-98. In: V. A. Fischetti (ed.), Gram-positive pathogens. American Society for Microbiology, Washington, D. C.

[9] Woods, C. R (2009). Macrolide-inducible resistance to clindamycin and the D-test. Pediatric Infectious Diseases Journal, 28, 1115-1118.

[10] Leclercq R. (2002). Mechanisms of resistance to macrolides and lincosamides: Nature of the resistance elements and their clinical implications. Clinical Infectious Diseases, 34, 482-492.

[11] Drinkovic D, Fuller ER, Shore KP, Holland DJ, and Ellis-Pegler R (2001) Clindamycin treatment of Staphylococcus aureus expressing inducible clindamycin resistance. Journal of Antimicrobial Chemotherapy, 48, 315-316.

[12] Fiebelkorn K. R., Crawford S. A., McElmeel M. L., and Jorgensen J. H (2003). Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulasenegative staphylococci. Journal Clinical of Microbiology; 41, 4740-4744.

[13] Siberry GK, Tekle T, Carroll K, and Dick J (2003). Failure of clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clinical Infectious Diseases,37, 1257-1260.

[14] Garner, J. S., Jarvis, W. R., Emori, T. G., Horan T. C. and Hughes, J. M. (1988). CDC definitions for nosocomial infections. American Journal of Infection Control, 16, 128-140.

[15] Cheesbrough, M. (2000). District laboratory practice in tropical countries (2), Cambridge University press, UK.

[16] Bauer, A. W., Kriby, W. M., Sherris, W. M. and Turk, J. C. (1966). Bauer-Kirbystandardized, single disc susceptibility, test for rapid growing pathogens. AmericanJournal of ClinicalPathology, 45, 493-498.

[17] Ajantha GS, Kulkarni RD, Shetty J, Shubhada C, and Jain P. (2008). Phenotypic detection of inducible clindamycin resistance among Staphylococcus aureus isolates by using the lower limit of recommended inter-disk distance. Indian Journal of Pathology Microbiology, 51, 376-378.

[18] Prabhu K, Rao S, and Rao V. (2011). Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Journal of Laboratory Physicians, 3, 25-27.

[19] Goyal R, Singh NP, Manchanda V, Mathur M. (2004). Detection of clindamycin susceptibility in macrolide resistant phenotypes of Staphylococcus aureus. Indian Journal Medical Microbiology, 22, 251-254.

[20] Shittu, A. O. and Lin, J. (2006). Antimicrobial susceptibility patterns and characterization of clinical isolates of Staphylococcus aureus in KwaZulu-Natal province, South Africa. BioMed Central Journal of Infectious Disease, 6(1), 125-137.

[21] Levin, T. P., Suh, B., Axelrod, P., Truant, A. L. and Fekete, T. (2005). Potential clindamycin resistance in clindamycin-susceptible, erythromycin-resistant Staphylococcus aureus: report of a clinical failure. Antimicrobial Agents and Chemotherapy, 49, 1222–1224.

[22] National Committee for Clinical Laboratory Standards (2004). Performance standards for antimicrobial disk susceptibility tests. 12th informational document NCCLS document M100-S14 2004, PA-NCCLS.

[23] Koppada R., Meeniga S., and Anke G (2015). Inducible Clindamycin Resistance among Staphylococcusaureus Isolated From Various Clinical Samples with Special Reference to MRSA. Scholars Journal of Applied Medical Sciences, 3(6D), 2374-2380.

[24] Baiu, S. H. and Al-Abdli, N. E. (2016). Inducible Clindamycin Resistance in Methicillin Resistant Staphylococcus aureus. American Journal of Infectious Diseases and Microbiology, 4(1), 25-27.

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Easter Godwin Nwokah, Samuel Douglas Abbey. (2016). Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria. American Journal of Clinical and Experimental Medicine, 4(3), 50-55. https://doi.org/10.11648/j.ajcem.20160403.13

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Easter Godwin Nwokah; Samuel Douglas Abbey. Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria. Am. J. Clin. Exp. Med. 2016, 4(3), 50-55. doi: 10.11648/j.ajcem.20160403.13

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Easter Godwin Nwokah, Samuel Douglas Abbey. Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria. Am J Clin Exp Med. 2016;4(3):50-55. doi: 10.11648/j.ajcem.20160403.13

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@article{10.11648/j.ajcem.20160403.13, author = {Easter Godwin Nwokah and Samuel Douglas Abbey}, title = {Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria}, journal = {American Journal of Clinical and Experimental Medicine}, volume = {4}, number = {3}, pages = {50-55}, doi = {10.11648/j.ajcem.20160403.13}, url = {https://doi.org/10.11648/j.ajcem.20160403.13}, eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajcem.20160403.13}, abstract = {Clindamycin is indicated in the treatment of skin and soft-tissue infections caused by Staphylococcal species. Treatment of an infection caused by a strain carrying inducible erm gene using clindamycin or any non-inducer macrolide can lead to clinical failure. The present study was aimed to detect inducible-clindamycin resistance (MLSBi) among S. aureus isolates in Port Harcourt, Nigeriaand to study the relationship between clindamycin and methicillin-resistant (MRSA).Two hundred and five (205) non-duplicate Staphylococcus aureus previously isolated from human sources were randomly collected from three health facilities- University of Port Harcourt Teaching Hospital, Braithwaite Memorial Specialist Hospital and De-Integrated Laboratories-all located in Port Harcourt, Nigeria, for this study from August, 2012 to July, 2013. Isolates were grouped as hospital in-patient (termed hospital- acquired – Nosocomial; n = 76) and out- patient cases (community-acquired; n = 129) Staphylococcus aureus . The isolates collected were reconfirmed following standard laboratory protocols. All confirmed isolates were stored in glycerol at +4°C (later sub-cultured for various phenotypic analyses). Using the disk diffusion method, detection of MRSA was carried out with 1μg of oxacillin (OXOID) placed on Mueller-Hinton agar with 4% NaCl supplementation).Antimicrobial susceptibility testing was performed using Erythromycin (15μg) and Clindamycin (2μg) both obtained from OXOID, UK. All clindamycin-sensitive isolates that were also erythromycin-resistant were subjected to D-Test phenotype (Inducible-clindamycin resistance). Among the 205 S. aureus isolates studied, Forty-four (21.5%) showed resistance to erythromycin, while 38 of these erythromycin-resistant isolates were simultaneously sensitive to clindamycin. Overall, out of 205 isolates, inducible-clindamycin resistance was detected in 23 (11.2%) of the isolates. These 23 (inducible MLSB phenotype) are among 38 erythromycin-resistant S. aureus that were simultaneously sensitive (phenotypically) to clindamycin. Ten (4.9%) of the total (205) study isolates expressed constitutive resistance to clindamycin. Oxacillin Resistance (MRSA) was detected in 25 (12.2%) of the 205 isolates. Among the 38 erythromycin-resistant S. aureus, four were MRSA while 3 (75%) of the 4 erythromycin-resistant MRSA expressed inducible resistance to clindamycin. 20 (58.8%) of 34 erythromycin-resistant MSSA expressed inducible resistance to clindamycin. MRSA phenotype was not significantly correlated (p=0.9430) to inducible-clindamycin resistance. Inducible clindamycin-resistance often leads to treatment failure. The clinical microbiology laboratories in Nigeria should consider routine testing and reporting of inducible clindamycin resistance in S. aureus . There is also the need for sustained surveillance of antimicrobial susceptibilities of S. aureus in this region.}, year = {2016} }

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TY - JOUR T1 - Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria AU - Easter Godwin Nwokah AU - Samuel Douglas Abbey Y1 - 2016/05/11 PY - 2016 N1 - https://doi.org/10.11648/j.ajcem.20160403.13 DO - 10.11648/j.ajcem.20160403.13 T2 - American Journal of Clinical and Experimental Medicine JF - American Journal of Clinical and Experimental Medicine JO - American Journal of Clinical and Experimental Medicine SP - 50 EP - 55 PB - Science Publishing Group SN - 2330-8133 UR - https://doi.org/10.11648/j.ajcem.20160403.13 AB - Clindamycin is indicated in the treatment of skin and soft-tissue infections caused by Staphylococcal species. Treatment of an infection caused by a strain carrying inducible erm gene using clindamycin or any non-inducer macrolide can lead to clinical failure. The present study was aimed to detect inducible-clindamycin resistance (MLSBi) among S. aureus isolates in Port Harcourt, Nigeriaand to study the relationship between clindamycin and methicillin-resistant (MRSA).Two hundred and five (205) non-duplicate Staphylococcus aureus previously isolated from human sources were randomly collected from three health facilities- University of Port Harcourt Teaching Hospital, Braithwaite Memorial Specialist Hospital and De-Integrated Laboratories-all located in Port Harcourt, Nigeria, for this study from August, 2012 to July, 2013. Isolates were grouped as hospital in-patient (termed hospital- acquired – Nosocomial; n = 76) and out- patient cases (community-acquired; n = 129) Staphylococcus aureus . The isolates collected were reconfirmed following standard laboratory protocols. All confirmed isolates were stored in glycerol at +4°C (later sub-cultured for various phenotypic analyses). Using the disk diffusion method, detection of MRSA was carried out with 1μg of oxacillin (OXOID) placed on Mueller-Hinton agar with 4% NaCl supplementation).Antimicrobial susceptibility testing was performed using Erythromycin (15μg) and Clindamycin (2μg) both obtained from OXOID, UK. All clindamycin-sensitive isolates that were also erythromycin-resistant were subjected to D-Test phenotype (Inducible-clindamycin resistance). Among the 205 S. aureus isolates studied, Forty-four (21.5%) showed resistance to erythromycin, while 38 of these erythromycin-resistant isolates were simultaneously sensitive to clindamycin. Overall, out of 205 isolates, inducible-clindamycin resistance was detected in 23 (11.2%) of the isolates. These 23 (inducible MLSB phenotype) are among 38 erythromycin-resistant S. aureus that were simultaneously sensitive (phenotypically) to clindamycin. Ten (4.9%) of the total (205) study isolates expressed constitutive resistance to clindamycin. Oxacillin Resistance (MRSA) was detected in 25 (12.2%) of the 205 isolates. Among the 38 erythromycin-resistant S. aureus, four were MRSA while 3 (75%) of the 4 erythromycin-resistant MRSA expressed inducible resistance to clindamycin. 20 (58.8%) of 34 erythromycin-resistant MSSA expressed inducible resistance to clindamycin. MRSA phenotype was not significantly correlated (p=0.9430) to inducible-clindamycin resistance. Inducible clindamycin-resistance often leads to treatment failure. The clinical microbiology laboratories in Nigeria should consider routine testing and reporting of inducible clindamycin resistance in S. aureus . There is also the need for sustained surveillance of antimicrobial susceptibilities of S. aureus in this region. VL - 4 IS - 3 ER -

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Easter Godwin Nwokah

Department of Medical Laboratory Science, Rivers State University of Science and Technology, Port Harcourt, Nigeria

Samuel Douglas Abbey

Department of Medical Laboratory Science, Rivers State University of Science and Technology, Port Harcourt, Nigeria

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Easter Godwin Nwokah, Samuel Douglas Abbey. (2016). Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria. American Journal of Clinical and Experimental Medicine, 4(3), 50-55. https://doi.org/10.11648/j.ajcem.20160403.13

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Easter Godwin Nwokah; Samuel Douglas Abbey. Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria. Am. J. Clin. Exp. Med. 2016, 4(3), 50-55. doi: 10.11648/j.ajcem.20160403.13

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Easter Godwin Nwokah, Samuel Douglas Abbey. Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria. Am J Clin Exp Med. 2016;4(3):50-55. doi: 10.11648/j.ajcem.20160403.13

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@article{10.11648/j.ajcem.20160403.13, author = {Easter Godwin Nwokah and Samuel Douglas Abbey}, title = {Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria}, journal = {American Journal of Clinical and Experimental Medicine}, volume = {4}, number = {3}, pages = {50-55}, doi = {10.11648/j.ajcem.20160403.13}, url = {https://doi.org/10.11648/j.ajcem.20160403.13}, eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajcem.20160403.13}, abstract = {Clindamycin is indicated in the treatment of skin and soft-tissue infections caused by Staphylococcal species. Treatment of an infection caused by a strain carrying inducible erm gene using clindamycin or any non-inducer macrolide can lead to clinical failure. The present study was aimed to detect inducible-clindamycin resistance (MLSBi) among S. aureus isolates in Port Harcourt, Nigeriaand to study the relationship between clindamycin and methicillin-resistant (MRSA).Two hundred and five (205) non-duplicate Staphylococcus aureus previously isolated from human sources were randomly collected from three health facilities- University of Port Harcourt Teaching Hospital, Braithwaite Memorial Specialist Hospital and De-Integrated Laboratories-all located in Port Harcourt, Nigeria, for this study from August, 2012 to July, 2013. Isolates were grouped as hospital in-patient (termed hospital- acquired – Nosocomial; n = 76) and out- patient cases (community-acquired; n = 129) Staphylococcus aureus . The isolates collected were reconfirmed following standard laboratory protocols. All confirmed isolates were stored in glycerol at +4°C (later sub-cultured for various phenotypic analyses). Using the disk diffusion method, detection of MRSA was carried out with 1μg of oxacillin (OXOID) placed on Mueller-Hinton agar with 4% NaCl supplementation).Antimicrobial susceptibility testing was performed using Erythromycin (15μg) and Clindamycin (2μg) both obtained from OXOID, UK. All clindamycin-sensitive isolates that were also erythromycin-resistant were subjected to D-Test phenotype (Inducible-clindamycin resistance). Among the 205 S. aureus isolates studied, Forty-four (21.5%) showed resistance to erythromycin, while 38 of these erythromycin-resistant isolates were simultaneously sensitive to clindamycin. Overall, out of 205 isolates, inducible-clindamycin resistance was detected in 23 (11.2%) of the isolates. These 23 (inducible MLSB phenotype) are among 38 erythromycin-resistant S. aureus that were simultaneously sensitive (phenotypically) to clindamycin. Ten (4.9%) of the total (205) study isolates expressed constitutive resistance to clindamycin. Oxacillin Resistance (MRSA) was detected in 25 (12.2%) of the 205 isolates. Among the 38 erythromycin-resistant S. aureus, four were MRSA while 3 (75%) of the 4 erythromycin-resistant MRSA expressed inducible resistance to clindamycin. 20 (58.8%) of 34 erythromycin-resistant MSSA expressed inducible resistance to clindamycin. MRSA phenotype was not significantly correlated (p=0.9430) to inducible-clindamycin resistance. Inducible clindamycin-resistance often leads to treatment failure. The clinical microbiology laboratories in Nigeria should consider routine testing and reporting of inducible clindamycin resistance in S. aureus . There is also the need for sustained surveillance of antimicrobial susceptibilities of S. aureus in this region.}, year = {2016} }

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TY - JOUR T1 - Inducible-Clindamycin Resistance in Staphylococcus aureus Isolates in Rivers State, Nigeria AU - Easter Godwin Nwokah AU - Samuel Douglas Abbey Y1 - 2016/05/11 PY - 2016 N1 - https://doi.org/10.11648/j.ajcem.20160403.13 DO - 10.11648/j.ajcem.20160403.13 T2 - American Journal of Clinical and Experimental Medicine JF - American Journal of Clinical and Experimental Medicine JO - American Journal of Clinical and Experimental Medicine SP - 50 EP - 55 PB - Science Publishing Group SN - 2330-8133 UR - https://doi.org/10.11648/j.ajcem.20160403.13 AB - Clindamycin is indicated in the treatment of skin and soft-tissue infections caused by Staphylococcal species. Treatment of an infection caused by a strain carrying inducible erm gene using clindamycin or any non-inducer macrolide can lead to clinical failure. The present study was aimed to detect inducible-clindamycin resistance (MLSBi) among S. aureus isolates in Port Harcourt, Nigeriaand to study the relationship between clindamycin and methicillin-resistant (MRSA).Two hundred and five (205) non-duplicate Staphylococcus aureus previously isolated from human sources were randomly collected from three health facilities- University of Port Harcourt Teaching Hospital, Braithwaite Memorial Specialist Hospital and De-Integrated Laboratories-all located in Port Harcourt, Nigeria, for this study from August, 2012 to July, 2013. Isolates were grouped as hospital in-patient (termed hospital- acquired – Nosocomial; n = 76) and out- patient cases (community-acquired; n = 129) Staphylococcus aureus . The isolates collected were reconfirmed following standard laboratory protocols. All confirmed isolates were stored in glycerol at +4°C (later sub-cultured for various phenotypic analyses). Using the disk diffusion method, detection of MRSA was carried out with 1μg of oxacillin (OXOID) placed on Mueller-Hinton agar with 4% NaCl supplementation).Antimicrobial susceptibility testing was performed using Erythromycin (15μg) and Clindamycin (2μg) both obtained from OXOID, UK. All clindamycin-sensitive isolates that were also erythromycin-resistant were subjected to D-Test phenotype (Inducible-clindamycin resistance). Among the 205 S. aureus isolates studied, Forty-four (21.5%) showed resistance to erythromycin, while 38 of these erythromycin-resistant isolates were simultaneously sensitive to clindamycin. Overall, out of 205 isolates, inducible-clindamycin resistance was detected in 23 (11.2%) of the isolates. These 23 (inducible MLSB phenotype) are among 38 erythromycin-resistant S. aureus that were simultaneously sensitive (phenotypically) to clindamycin. Ten (4.9%) of the total (205) study isolates expressed constitutive resistance to clindamycin. Oxacillin Resistance (MRSA) was detected in 25 (12.2%) of the 205 isolates. Among the 38 erythromycin-resistant S. aureus, four were MRSA while 3 (75%) of the 4 erythromycin-resistant MRSA expressed inducible resistance to clindamycin. 20 (58.8%) of 34 erythromycin-resistant MSSA expressed inducible resistance to clindamycin. MRSA phenotype was not significantly correlated (p=0.9430) to inducible-clindamycin resistance. Inducible clindamycin-resistance often leads to treatment failure. The clinical microbiology laboratories in Nigeria should consider routine testing and reporting of inducible clindamycin resistance in S. aureus . There is also the need for sustained surveillance of antimicrobial susceptibilities of S. aureus in this region. VL - 4 IS - 3 ER -

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Published in	American Journal of Clinical and Experimental Medicine (Volume 4, Issue 3)
DOI	10.11648/j.ajcem.20160403.13
Page(s)	50-55
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2016. Published by Science Publishing Group

[1]	Shittu, A. O., Lin, J. and Kolawole, D. O. (2006). Antimicrobial susceptibility patterns of Staphylococcus aureus and characterization of MRSA in Southwestern Nigeria. Wounds, 18, 77-84.
[2]	Shittu, A., Oyedara, O., Abegunrin, F. Okon, K. Raji, A. Taiwo, S. Ogunsola, F., Onyedibe, K. and Elisha, G. (2012). Characterization of methicillin-susceptible and -resistant staphylococci in the clinical setting: a multicentre study in Nigeria. Biomed Central Infectious Diseases, 12, 286-295.
[3]	Nwokah, E. G. Obunge, O. K, Ayodele, M. B. O., Abbey, S. D. and Tatfeng, Y. M. (2012). Nasal Carriage of Staphylococcus aureus and MRSA among Food Handlers in a Sub-Urban Setting in Rivers State, Nigeria. Nigerian Biomedical Science Journal, 8 (3), 58-61.
[4]	Okwu, M. U., Okorie, T. G., Mitsan, O. and Osakue, E. O. (2014). Prevalence and comparison of three methods for detection of methicillin-resistant Staphylococcus aureus (MRSA) isolates in tertiary health institutions in Nigeria. Canadian Open Biological Sciences Journal, 1 (1), 1–12.
[5]	Delialioglu N, Aslan G, Ozturk C, Baki V, Sen S, and Emekdas G. (2005). Inducible clindamycin resistance in staphylococci isolated from clinical samples. Japan Journal ofInfectious Disease, 58, 104–106.
[6]	Deotale V, Mendiratta DK, Raut U, and Narang P (2010). Inducible clindamycin resistance in Staphylococcus aureusisolated from clinical samples. Indian Journal Medical Microbiology, 28,124–126.
[7]	Leclercq R., R. B. Giannattasio, H. J. Jin, and B. Weisblum (1991). Bacterial resistance to macrolide, lincosamide and streptogramin antibiotics by target modification. Antimicrobial Agents Chemotherapy, 35,1267-1272.
[8]	Weisblum B (1999) Resistance to macrolide-lincosamide-streptogramin antibiotics, p. 682-98. In: V. A. Fischetti (ed.), Gram-positive pathogens. American Society for Microbiology, Washington, D. C.
[9]	Woods, C. R (2009). Macrolide-inducible resistance to clindamycin and the D-test. Pediatric Infectious Diseases Journal, 28, 1115-1118.
[10]	Leclercq R. (2002). Mechanisms of resistance to macrolides and lincosamides: Nature of the resistance elements and their clinical implications. Clinical Infectious Diseases, 34, 482-492.
[11]	Drinkovic D, Fuller ER, Shore KP, Holland DJ, and Ellis-Pegler R (2001) Clindamycin treatment of Staphylococcus aureus expressing inducible clindamycin resistance. Journal of Antimicrobial Chemotherapy, 48, 315-316.
[12]	Fiebelkorn K. R., Crawford S. A., McElmeel M. L., and Jorgensen J. H (2003). Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulasenegative staphylococci. Journal Clinical of Microbiology; 41, 4740-4744.
[13]	Siberry GK, Tekle T, Carroll K, and Dick J (2003). Failure of clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clinical Infectious Diseases,37, 1257-1260.
[14]	Garner, J. S., Jarvis, W. R., Emori, T. G., Horan T. C. and Hughes, J. M. (1988). CDC definitions for nosocomial infections. American Journal of Infection Control, 16, 128-140.
[15]	Cheesbrough, M. (2000). District laboratory practice in tropical countries (2), Cambridge University press, UK.
[16]	Bauer, A. W., Kriby, W. M., Sherris, W. M. and Turk, J. C. (1966). Bauer-Kirbystandardized, single disc susceptibility, test for rapid growing pathogens. AmericanJournal of ClinicalPathology, 45, 493-498.
[17]	Ajantha GS, Kulkarni RD, Shetty J, Shubhada C, and Jain P. (2008). Phenotypic detection of inducible clindamycin resistance among Staphylococcus aureus isolates by using the lower limit of recommended inter-disk distance. Indian Journal of Pathology Microbiology, 51, 376-378.
[18]	Prabhu K, Rao S, and Rao V. (2011). Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Journal of Laboratory Physicians, 3, 25-27.
[19]	Goyal R, Singh NP, Manchanda V, Mathur M. (2004). Detection of clindamycin susceptibility in macrolide resistant phenotypes of Staphylococcus aureus. Indian Journal Medical Microbiology, 22, 251-254.
[20]	Shittu, A. O. and Lin, J. (2006). Antimicrobial susceptibility patterns and characterization of clinical isolates of Staphylococcus aureus in KwaZulu-Natal province, South Africa. BioMed Central Journal of Infectious Disease, 6(1), 125-137.
[21]	Levin, T. P., Suh, B., Axelrod, P., Truant, A. L. and Fekete, T. (2005). Potential clindamycin resistance in clindamycin-susceptible, erythromycin-resistant Staphylococcus aureus: report of a clinical failure. Antimicrobial Agents and Chemotherapy, 49, 1222–1224.
[22]	National Committee for Clinical Laboratory Standards (2004). Performance standards for antimicrobial disk susceptibility tests. 12th informational document NCCLS document M100-S14 2004, PA-NCCLS.
[23]	Koppada R., Meeniga S., and Anke G (2015). Inducible Clindamycin Resistance among Staphylococcusaureus Isolated From Various Clinical Samples with Special Reference to MRSA. Scholars Journal of Applied Medical Sciences, 3(6D), 2374-2380.
[24]	Baiu, S. H. and Al-Abdli, N. E. (2016). Inducible Clindamycin Resistance in Methicillin Resistant Staphylococcus aureus. American Journal of Infectious Diseases and Microbiology, 4(1), 25-27.