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Uh, Hwang, Jang, Kwon, Yoon, and Kim: Distributions of Macrolide-Lincosamide-Streptogramin B Resistance Phenotypes in Clinical Isolates of Staphylococi
Original Article

Korean J Clin Microbiol 2008;11(2):78-83.

Published online: 20 October 2008

DOI: https://doi.org/10.5145/kjcm.2008.11.2.78

Distributions of Macrolide-Lincosamide-Streptogramin B Resistance Phenotypes in Clinical Isolates of Staphylococi

Young Uh1, , Gyu Yul Hwang1, Ih Ho Jang1, Ohgun Kwon1, Kap Jun Yoon1, Hyo Youl Kim2

1Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

2Department of Infectious Diseases, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence: Young Uh, Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju 220-701, Korea. (Tel) 82-33-741-1592, (Fax) 82-33-731-0506, (E-mail) u931018@yonsei.ac.kr

Received 5 August 2008       Revised 10 September 2008

Copyright © 2008 Korean Journal of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Increased resistance rates to macrolide-lincosamide-streptogramin B (MLSB) antibiotics among clinical isolates of staphylococci are considered as a consequence of an expanded use of these antibiotics in the treatment of Gram-positive infections. The proportion of MLSB resistance phenotypes of staphylococci is quite different by geographical variations and study periods. The aim of the present study was to determine the distribution of MLSB resistance phenotypes among clinical isolates of staphylococci in a university hospital.

Methods

The MLSB resistance phenotypes of clinical isolates of staphylococci were investigated by the double-disk diffusion test using erythromycin and clindamycin disks.

Results

Of 7,916 isolates, 55.7% exhibited a constitutive resistance phenotype (cMLSB) whereas 8.1% expressed an inducible resistance phenotype (iMLSB). Among 3,419 coagulase-negative staphylococci (CNS), 32.6% and 10.0% exhibited cMLSB and iMLSB resist-ance phenotypes, respectively. Of 4,497 Staphylococcus aureus isolates, 73.1% and 6.8% were cMLSB and iMLSB resistance phenotypes, respectively. cMLSB was detected among 90.2% of methicillin-resistant S. aureus (MRSA), 46.5% of methicillin-resistant CNS (MRCNS), 3.2% of methicillin-susceptible CNS (MSCNS), and 2.2% of methicillin-susceptible S. aureus (MSSA). iMLSB was detected among 16.5% of MSSA, 11.5% of MRCNS, 6.7% of MSCNS, and 4.4% of MRSA.

Conclusion

MLSB resistance was more prevalent among S. aureus isolates than CNS strains. Although cMLSB was the most frequently detected resistance phenotype among the total staphylococcal isolates, methicillin-susceptible strains exhibited somewhat higher iMLSB resistance rates compared with methi-cillin-resistant strains.

Keywords: Staphylococci, Staphylococcus aureus, MLSB resistance, Constitutive, Inducible

References

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Table 1.
Distribution of macrolide-lincosamide-streptogramin B (MLSB) resistance phenotypes of Staphylococcus species
Organisms MLSB No. (%) cMLSB No. (%) iMLSB No. (%) ERYSCLIR No. (%)
S. aureus        
MRSA (3626) 3431 (94.6) 3271 (90.2) 160 (4.4)0 4 (0.1)
MSSA (871) 163 (18.7) 19 (2.2)0 114 (16.5) 1 (0.1)
Subtotal (4497) 3594 (79.9) 3290 (73.1) 304 (6.8)0 5 (0.1)
CNS        
MRCNS (2322) 1347 (58.0) 1080 (46.5) 267(11.5) 44 (1.9)
MSCNS (1097) 109 (9.9)0 35 (3.2)0 74 (6.7)0 9 (0.8)
Subtotal (3419) 1456 (42.6) 1115 (32.6) 341 (10.0) 53 (1.6)
Total (7916) 5050 (63.8) 4405 (55.7) 645 (8.1)0 58 (0.7)

Abbreviations: cMLSB, constitutive MLSB resistance phenotype; iMLSB, inducible MLSB resistance phenotype; ERY

S CLI

R erythromycin-susceptible and clindamycin-resistant; MRSA, methicillin-resistant S. aureus; MSSA, methicillin-susceptible S. aureus; CNS, coagulase-negative staphylococci; MRCNS, methicillin-resistant CNS; MSCNS, methicillin-susceptible CNS.

Table 2.
Distributions of MLSB resistance phenotypes of Staphylococcus species according to patients' classification
Classification (No.) ERYSCLIS No. (%) cMLSB No. (%) iMLSB No. (%) ERYSCLIR No. (%)
Community-acquired        
MRSA (499) 95 (19.1) 324 (64.9) 79 (15.8) 1 (0.2)
MSSA (546) 459 (84.0) 8 (1.5) 78 (14.3) 1 (0.2)
Subtotal (1045) 554 (53.0) 332 (31.8) 157 (15.0) 2 (0.2)
MRCNS (1212) 651 (53.7) 349 (28.8) 192 (15.8) 20 (1.7)
MSCNS (810) 722 (89.1) 20 (2.5) 61 (7.5) 7 (0.9)
Subtotal (2022) 1373 (67.9) 369 (18.3) 253 (12.5) 27 (1.3)
Hospital-acquired
MRSA (3127) 96 (3.1) 2947 (94.2) 81 (2.6) 3 (0.1)
MSSA (325) 248 (76.3) 11 (3.4) 66 (20.3) 0 (0)
Subtotal (3452) 344 (9.9) 2958 (85.7) 147 (4.3) 3 (0.1)
MRCNS (1110) 280 (25.2) 731 (65.8) 75 (6.8) 24 (2.2)
MSCNS (287) 257 (89.6) 15 (5.2) 13 (4.5) 2 (0.7)
Subtotal (1397) 537 (38.4) 746 (53.4) 88 (6.3) 26 (1.9)

Abbreviations: ERY

S CLI

S erythromycin-susceptible and clindamycin-susceptible; Others, see Table 1.

Table 3.
Antibiotic susceptibilities of Staphylococcus aureus according to MLSB resistance phenotypes and patients' classification
Classification (No.) Tetracycline No. (%) TMP/SMX No. (%) Ciprofloxacin No. (%) Arbekacin No. (%)
Community-acquired
MRSA        
cMLSB 14 (4.3) 284 (87.7) 5 (1.5) 306 (94.4)
iMLSB ERYSCLIR 49 (62.0) 1 (100) 73 (92.4) 1 (100) 49 (62.0) 1 (100) 76 (96.2) 1 (100)
ERYSCLIS 83 (87.4) 91 (95.8) 84 (88.8) 91 (95.8)
Subtotal 147 (29.5) 449 (90.0) 139 (27.9) 474 (95.0)
MSSA
cMLSB 4 (50.0) 7 (87.5) 7 (87.5) 8 (100)
iMLSB 73 (93.6) 78 (100) 74 (94.9) 74 (94.9)
ERYSCLIR 0 (0) 1 (100) 0 (0) 1 (100)
ERYSCLIS 422 (91.9) 459 (100) 451 (98.3) 439 (95.6)
Subtotal 499 (91.4) 545 (99.8) 532 (97.4) 522 (95.6)
Hospital-acquired
MRSA        
cMLSB 270 (9.2) 2808 (95.3) 13 (0.4) 2748 (93.2)
iMLSB 47 (58.0) 71 (87.7) 46 (56.8) 78 (96.3)
ERYSCLIR 1 (33.3) 0 (0) 0 (0) 3 (100)
ERYSCLIS 90 (93.8) 93 (96.9) 84 (87.5) 93 (96.9)
Subtotal 408 (13.0) 2972 (95.0) 143 (4.6) 2922 (93.4)
MSSA
cMLSB 7 (63.6) 10 (90.9) 6 (54.5) 11 (100)
iMLSB 64 (97.0) 66 (100) 65 (98.5) 63 (95.5)
ERYSCLIS 233 (94.0) 247 (99.6) 239 (96.4) 239 (96.4)
Subtotal 304 (93.5) 323 (99.4) 310 (95.4) 313 (96.5)

Abbreviations: TMP/SMX, trimethoprim/sulfamethoxazole; Others, see Table 1 and Table 2.

Table 4.
Prevalence of MLSB resistance phenotypes of methicillin-resistant Staphylococcus aureus according to isolation years and patients' classification
Classification No. (%) by year
2005 2006 2007 2008
Community-acquired
cMLSB 31 (38.7) 254 (37.6) 284 (41.5) 104 (38.4)
iMLSB 16 (20.0) 118 (17.5) 102 (14.9) 35 (12.9)
ERYSCLIR 1 (1.3)0 12 (1.8)0 5 (0.7)0 3 (1.1)0
ERYSCLIS 32 (40.0) 291 (43.1) 294 (42.9)0 129 (47.6)
Subtotal 80 (100) 675 (100) 685 (100) 271 (100)
Hospital-acquired
cMLSB 236 (89.3) 1198 (85.4) 1609 (87.2) 635 (87.5)
iMLSB 11 (4.2)0 66 (4.7)0 59 (3.2)0 20 (2.8)0
ERYSCLIR 1 (0.4)0 4 (0.3)0 14 (0.8)0 8 (1.1)0
ERYSCLIS 16 (6.1)0 135 (9.6)0 162 (8.8)0 63 (8.7)0
Subtotal 264 (100)0 1403 (100) 1844 (100) 726 (100)

Abbreviations: see Table 1 and Table 2.

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