Inducible Clindamycin Resistant Staphylococcus aureus in Iran: A Systematic Review and Meta-analysis

Ahmadreza Zarifian; Yasin Setayesh; Emran Askari; Aminreza Amini; Mohammad Rahbar; Mahboubeh Naderinasab

Journal of Medical Bacteriology (Nov 2015)

Inducible Clindamycin Resistant Staphylococcus aureus in Iran: A Systematic Review and Meta-analysis

Ahmadreza Zarifian,
Yasin Setayesh,
Emran Askari,
Aminreza Amini,
Mohammad Rahbar,
Mahboubeh Naderinasab

Affiliations

Ahmadreza Zarifian: Student Research Committee, Mashhad University of Medical Sciences, Mashhad, IR Iran
Yasin Setayesh: Student Research Committee, Mashhad University of Medical Sciences, Mashhad, IR Iran
Emran Askari: Student Research Committee, Mashhad University of Medical Sciences, Mashhad, IR Iran
Aminreza Amini: Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, IR Iran
Mohammad Rahbar: Department of Microbiology, Reference Health Laboratories Research Center, Deputy of Health, Ministry of Health and Medical Education, Tehran, IR Iran AND Antimicrobial Resistance Research Center, Tehran University of Medical sciences, Tehran, IR Iran
Mahboubeh Naderinasab: Microbiology Laboratory, Central Laboratory, Imam Reza Hospital, Mashhad, IR Iran

Journal volume & issue: Vol. 4, no. 1-2
pp. 43 – 52

Abstract

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Introduction: Staphylococcus aureus is a prominent human pathogen. One of the drugs used in the treatment of staphylococcal infections (particularly infections of skin and soft tissue), is clindamycin. Resistance to clindamycin includes two types: inducible and constitutive. Routine laboratory methods of antibiotic susceptibility testing cannot detect the inducible type and D- test is required for its detection. The purpose of this systematic review was to determine the relative prevalence of this type of resistance in Iran.Methods: Search terms "inducible clindamycin resistant", "D-test", "Staphylococcus aureus" and "Iran" were used to find relevant articles in PubMed, Google Scholar and two Persian search engines. Also, the abstracts of the recent national microbiology congresses were checked.All studies used D-test to find iMLSB (inducible macrolide, lincosamide and streptograminB resistance) phenotype among clinical isolates (not nasal swabs) of S. aureus, were included. In order to perform meta-analysis, we used “comprehensive meta-analysis” software (ver. 2).Results: In total, 9 articles and 8 abstracts related to the topic of the study were found. Random effects meta-analyses showed a pooled estimate for percentage of iMLSB phenotype among 2683 samples of S. aureus was about 10% (95% confidence interval: 0.07-0.12). Using the fixed effect model, the odds of positive iMLSB in methicillin-resistant S. aureus was about 5 times more likely to occur in comparison with methicillin-susceptible S. aureus (95% CI: 3.49 to 7.76).Conclusion: Fortunately, the relative frequency of inducible resistance to clindamycin in our country is relatively low. However, we believe that D-test should be performed for all erythromicin-resistant isolates in order to identify inducible resistance to clindamycin.Moreover, reevaluation of inducible reistance to clindamycin in forthcoming years is highly recommended.

Staphylococcus aureus, Inducible resistance, Cindamycin, Iran, Systematic review

Published in Journal of Medical Bacteriology

ISSN: 2251-8649 (Print); 2322-2581 (Online)
Publisher: Tehran University of Medical Sciences
Country of publisher: Iran, Islamic Republic of
LCC subjects: Medicine
Website: http://jmb.tums.ac.ir

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