Journal Article

Failure of Clindamycin Treatment of Methicillin-Resistant <i>Staphylococcus aureus</i> Expressing Inducible Clindamycin Resistance In Vitro

George K. Siberry, Tsigereda Tekle, Karen Carroll and James Dick

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 37, issue 9, pages 1257-1260
Published in print November 2003 | ISSN: 1058-4838
Published online November 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/377501
Failure of Clindamycin Treatment of Methicillin-Resistant Staphylococcus aureus Expressing Inducible Clindamycin Resistance In Vitro

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We report a case of a surgical site infection caused by clindamycin-susceptible, erythromycin-resistant methicillin-resistant Staphylococcus aureus (MRSA) that did not respond to treatment with clindamycin. The MRSA isolate obtained after treatment was resistant to clindamycin but was found to be identical by pulsed-field gel electrophoresis to the clindamycin-susceptible isolate obtained before treatment. A post hoc erythromycin-induction test (D test) confirmed the presence of in vitro inducible macrolide-lincosamide-streptogramin B resistance (iMLS) in the pretreatment isolate. Erythromycin induction testing confirmed in vitro iMLS in 90 (56%) of 161 erythromycin-resistant, clindamycin-susceptible clinical S. aureus isolates overall and in a significantly higher proportion (78%) of methicillin-susceptible S. aureus isolates from pediatric patients. Our clinical laboratory currently tests all S. aureus isolates for iMLS before reporting clindamycin susceptibility.

Journal Article.  1458 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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