Hamzullah Khan*, Fazli Bari, Tayyaba Basharat, Mohammad Basharat Khan, Saadullah and Shabbir Hussain
Objectives: Phenotypic detection of erm gene encoding enzyme in methicillin sensitive and methicillin resistant Staphylococcus aureus isolates (sputum and pus samples) in a tertiary care hospital of Nowshera and to find the sensitivity pattern to D+MSSA and D+MRSA.
Methods: This prospective cohort study was performed in the pathology laboratory of Qazi Hussain Ahmed Medical Complex Nowshera from 1st March 2019 to 30th Sept 2019. A total of 186 S. aureus isolates were selected for routine antibiotic susceptibility testing. 52 samples showed D-test positive i.e., (induced clindamycine resistance). Relevant information were recorded on a predesigned proforma prepared as per CLSI recommendation for data collection.
Results: Out of 186 patients Staph aureus isolates were selected for antibiotic susceptibility, 52 (27.95%) isolates showed inducible clindamycin resistance using D-test as per CLSI recommendations. Out of total, 30 (57.7%) were females and 22 (42.3%) were males. The mean age with standard deviation was 28.36 ± 3.8. The age range was from 15 years to 45 years of age. Mode of age was 23 years. In 45 (86.5%) cases D-test phenomenon was observed in MRSA while in 7 (13.5%) cases it was also noted in Methicillin Sensitive Staph aureus (MSSA). 36 (69.23%) patients with phenotypically positive erm gene encoding methylase were referred from medical unit of QHAMC. The sensitivity pattern to D+MRSA was; vancomycine 94.23%, lanezolid 94.23%, rifampicin 84.23%, fusidic acid 55.77%, doxycyclin 32.59%, levofloxacin 21.15%, gentamycine 13.46%, ciprofloxacin 13.46%.
It is pertinent to mention that the sensitivity to amoxicillin, cefradine, ceftriaxone was seen only in cases with D+MSSA cases only (13.5%) cases. While no isolate sensitivity to co-trimaxazole.
The sensitivity to vancomycine and lanezolid was 100% in both D+MSSA and D+ MRSA but was not reported in cases of D+MSSA to the clinicians to avoid its misuse of these precious drugs for simple D +MSSA cases that can easily be treated with alternative b-lactam antibiotics.
Conclusion: D+MSSA cases where sensitive to b-lactam antibiotics and shall be treated with these conventional antibiotics and precious drug like vancomycine and lanezolid should be kept reserved for D+MRSA cases to avoid misuse of antibiotics and to reduce resistance. D+type of resistant infection are now a challenge to the clinician to treat and is a public health threat that needs accumulative response through advocacy, communication and social mobilization.
Published Date: 2024-07-29; Received Date: 2020-07-29
