Prevalence of Inducible Macrolide-Lincosamide-Streptogramin B (MLSB) Resistance in Erythromycin-Resistant Staphylococci

Kyung-Hee Kim; Soon-Ho Park; Pil-Whan Park; Jeong-Yeal Ahn; Yiel-Hea Seo

doi:10.3947/ic.2010.42.3.171

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Kim, Park, Park, Ahn, and Seo: Prevalence of Inducible Macrolide-Lincosamide-Streptogramin B (MLSB) Resistance in Erythromycin-Resistant Staphylococci

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(3): 171-174.

Published online: 30 June 2010

DOI: https://doi.org/10.3947/ic.2010.42.3.171

Prevalence of Inducible Macrolide-Lincosamide-Streptogramin B (MLS_B) Resistance in Erythromycin-Resistant Staphylococci

Kyung-Hee Kim, Soon-Ho Park, Pil-Whan Park, Jeong-Yeal Ahn, Yiel-Hea Seo

Department of Laboratory Medicine, Gachon University Gil Hospital, Incheon, Korea.

Corresponding author: Yiel-Hea Seo. Department of Laboratory Medicine, Gachon Universitity Gil Hospital, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea. Tel: +82-32-460-3074, Fax: +82-32-460-3415, seoyh@gilhospital.com

Received 20 August 2009 Revised 25 March 2010 Accepted 25 March 2010

(open-access):

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

Inducible MLS_B (macrolide-lincosamide-streptogramin B) resistance in staphylococci is not detected by standard susceptibility test methods. Failure to identify inducible MLS_B resistance may lead to clinical failure during clindamycin therapy. We determined the prevalence of inducible MLS_B resistance in erythromycin-resistant staphylococcal isolates.

Materials and Methods

We evaluated all 2,792 non-duplicate staphylococcal strains: 1,402 Staphylococcus aureus and 1,390 coagulase-negative staphylococci (CoNS) isolated from May 2008-June 2009 at one-unoversity hospital. Testing for inducible MLS_B was accomplished by the disk approximation test (D-test) in accordance with the recommendations of the Clinical and Laboratory Standards Institute (CLSI).

Results

Of the 2,792 staphylococcal isolates, 892 S. aureus isolates and 740 CoNS isolates were resistant to erythromycin. Among the 892 erythromycin-resistant S. aureus isolates, the overall prevalence of inducible MLS_B was 21.3% (16.2% of MRSA and 76.3% of methicillin-susceptible S. aureus). Among the 740 erythromycin-resistant CoNS isolates, the overall prevalence of inducible MLS_B was 16.5% (16.0% of methicillin-resistant CoNS and 18.7% of methicillin-susceptible CoNS). The D-test was positive in 88.8% of S. aureus and 28.4% of CoNS isolates, which were erythromycin-resistant and clindamycin-susceptible.

Conclusions

There are some variations in the prevalence of inducible MLSB resistance in clinical staphylococcal isolates. It is important that clinical laboratories report inducible MLS_B resistance for erythromycin-resistant and clindamycinsusceptible staphylococcal isolates.

Keywords: Staphylococcus, Clindamycin, Inducible, Resistance

Figures and Tables

Table 1

Antimicrobial Resistance of All Staphylococcal Isolates (n=2,792)

Abbreviations: MRSA, methicillin-resistant S. aureus; MSSA, methicillin-susceptible S. aureus; CoNS, coagulase-negative staphylococci; MRCoNS, methicillin-resistant CoNS; MSCoNS, methicillin-susceptible CoNS.

Table 2

Phenotype Distribution of MLS_B Resistance of Erythromycin Resistant Staphylococcal Isolates

Abbreviations: cMLS_B, constitutive MLS_B resistance; iMLS_B, inducible MLS_B resistance; MS_B, only macrolide-streptogramin B resistance; E^RC^S, erythromycin-resistant, clindamycinsusceptible.

^*Percentage among the erythromycin-resistant and clindamycin-susceptible isolates.

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