Practical Disk Diffusion Method for Detection of Inducible Clindamycin Resistance in <i>Staphylococcus aureus</i> and Coagulase-Negative Staphylococci

TLDR

Macrolide resistance in staphylococci arises from efflux (msrA) or ribosomal target modification (ermA/ermC), with MLS B resistance being either constitutive or inducible after macrolide exposure. The study evaluated whether placing erythromycin and clindamycin disks 26–28 mm apart in a standard dispenser reliably detects inducible MLS B resistance compared to 15 or 20 mm spacing. Induction was assessed by disk approximation, where a flattened clindamycin zone adjacent to an erythromycin disk signals inducible MLS B, and 130 S. aureus and 100 CNS isolates were tested, with PCR for ermA, ermC, and msrA performed on selected strains.

Abstract

ABSTRACT Resistance to macrolides in staphylococci may be due to active efflux (encoded by msrA ) or ribosomal target modification (macrolide-lincosamide-streptogramin B [MLS B ] resistance; usually encoded by ermA or ermC ). MLS B resistance is either constitutive or inducible following exposure to a macrolide. Induction tests utilize closely approximated erythromycin and clindamycin disks; the flattening of the clindamycin zone adjacent to the erythromycin disk indicates inducible MLS B resistance. The present study reassessed the reliability of placing erythromycin and clindamycin disks in adjacent positions (26 to 28 mm apart) in a standard disk dispenser, compared to distances of 15 or 20 mm. A group of 130 clinical isolates of Staphylococcus aureus and 100 isolates of erythromycin-resistant coagulase-negative staphylococci (CNS) were examined by disk approximation; all CNS isolates and a subset of S. aureus isolates were examined by PCR for ermA , ermC , and msrA . Of 114 erythromycin-resistant S. aureus isolates, 39 demonstrated constitutive resistance to clindamycin, while 33 showed inducible resistance by disk approximation at all three distances. Only one isolate failed to clearly demonstrate induction at 26 mm. Of 82 erythromycin-resistant CNS isolates that contained ermA or ermC , 57 demonstrated constitutive clindamycin resistance, and 25 demonstrated inducible resistance, at 20 and 26 mm. None of the 42 S. aureus isolates or 18 CNS isolates containing only msrA and none of the erythromycin-susceptible isolates yielded positive disk approximation tests. Simple placement of erythromycin and clindamycin disks at a distance achieved with a standard disk dispenser allowed detection of 97% of S. aureus strains and 100% of CNS strains with inducible MLS B resistance in this study.