Inducible Clindamycin-Resistant Staphylococcus aureus Strains in Africa: A Systematic Review

Abstract

Introduction. Excessive use of clindamycin enhances the acquisition of inducible clindamycin-resistant S. aureus strains, which is a significant health problem in Africa. The main objective of this review study was to determine the prevalence of inducible clindamycin resistance and related genes among S. aureus isolates in Africa. Methods. A qualitative systematic review was conducted on inducible clindamycin resistance among S. aureus isolates in Africa using electronic databases such as Google Scholar and PubMed. Articles published in English before 2021 were selected, and relevant data were extracted, collected, and analyzed. Results. In our search, 22 articles met the eligibility criteria for this review study. Of 3064 total S. aureus isolates, 605 had iMLSB phenotype. The overall prevalence of inducible clindamycin resistance in S. aureus isolates was 19.8% with a range of 2.9% to 44.0%. A high number of iMLSB phenotypes were observed in MRSA isolates (3.6–77.8%) than MSSA (0–58.8%). The overall prevalence of the iMLSB phenotype in MRSA strains was 26.8% (279/1041). The maximum peak prevalence of inducible clindamycin resistance among S. aureus isolates recorded in the continent was 44.0% in Egypt, followed by 35.8% in Libya and 33.3% in Uganda in 2017, 2007, and 2013, respectively. The highest prevalence of iMLSB phenotype in MRSA strains was reported in Egypt, 77.8%, followed by Nigeria, 75.0%, and Libya, 66.2%. Among the recovered drug-resistance genes, ermA, ermC, and msrA genes were commonly detected in Egypt with 67.9%, 70.0%, and 70.0% prevalence, respectively. Conclusion. This review highlights a higher inducible resistance of S. aureus, including MRSA strains to clindamycin in the continent. Regular screening of these strains, wise use of clindamycin, and molecular detection and genotyping of resistant genes are urgent.

Evaluation of the efficacy of antibiotics in the treatment of Staphylococcus aureus isolated from clinical cases in Al-Dawwaniyah hospitals

“…As for macrolides antibiotics, the rate of resistance to erythromycin was 59% as it is very close to the study (Hashemzadeh et al 2021) Where bacteria resisted this antibacterial by 58%, the reason for the high percentage of resistance as a result of its use These antibiotics are widely used to treat staphylococcal infection in Iraq, and this is an indication of resistance to modern macrolides such as Clarithromycin According to a study (Goyal et al 2004), where the rate of resistance to the antibiotic Clarithromycin was 40%, and this result is consistent with what was reached (Zhou, Li, and Yan 2020).As for the antibiotic Azithromycin, where the results we obtained are 57%, the same as what was found in the study (Asbell, Sanfilippo, and Mah 2022) . As for the antibiotic Clindamycin, it recorded a resistance rate of 35%, which is higher than the percentage recorded in the study The same precedent (Assefa 2022) where the percentage was 19,8% .…”

The antimicrobial activity of cethromycin against Staphylococcus aureus and its relationship with MLST, erm genes and MLSB phenotypes

“…A total of 245S. aureus isolates[Isolated from sputum (79), throat swabs (46), blood (39), pus (35), catheters (24), pleural effusion (14), and cerebrospinal uid (8)] were retrospectively collected from the inpatients of Shenzhen Nanshan People's Hospital (which includes 1200 beds), Shenzhen University in China, from 1 January 2012 to 31 December 2015. All clinical isolates were identi ed with the Phoenix 100 automated microbiology system (BD, Franklin Lakes, NJ, USA) and matrix-assisted laser desorption ionization time-of-ight mass spectrometry (IVD MALDI Biotyper, Germany).…”

“…Lincosamides and Streptogramins B are two kinds of drugs with different structures but the same action targets and similar functions as macrolide antimicrobials, thus they are called Macrolide-Lincosamide-Streptogramin B (MLSB) antimicrobials [13]. The MLSB phenotype can be divided into constitutive (cMLSB phenotype: rRNA methylase is always produced), or inducible (iMLSB phenotype: methylase is produced only when an inducing substance like erythromycin is present) [14]. U.S Clinical and Laboratory Standards Institute (CLSI) suggested that the inducible clindamycin-resistant test (D test) should be conducted to distinguish the phenotypes of iMLSB and cMLSB [15].…”

The antimicrobial activity of cethromycin against Staphylococcus aureus and compared with erythromycin and telithromycin

“…Lincosamides and Streptogramins B are two kinds of drugs with different structures but the same action targets and similar functions as macrolide antimicrobials, thus they are called Macrolide-Lincosamide- Streptogramin B (MLSB) antimicrobials [ 13 ]. The MLSB phenotype can be divided into constitutive MLSB (cMLSB phenotype: rRNA methylase is always produced), or inducible MLSB (iMLSB phenotype: methylase is produced only when an inducing substance like erythromycin is present) [ 14 ]. U.S Clinical and Laboratory Standards Institute (CLSI) suggested that the inducible clindamycin-resistant test (D-test) should be conducted to distinguish the phenotypes of iMLSB and cMLSB [ 15 ].…”