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

Abstract

<p><strong><em>Introduction</em></strong>: <em>S</em><em>taphylococcus aureus </em>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.</p><p><strong><em>M</em></strong><strong><em>e</em></strong><strong><em>thods</em></strong>: Search terms "inducible clindamycin resistant", "D-test", "<em>Staphylococcus aureus</em>" 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 <em>S. aureus</em>, were included. In order to perform meta-analysis, we used “comprehensive meta-analysis” software (ver. 2).</p><p><strong><em>Results</em></strong>: 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 <em>S. aureus </em>was about 10% (95% confidence interval: 0.07-0.12). Using the fixed effect model, the odds of positive iMLSB  in methicillin-resistant <em>S. aureus </em>was about 5 times more likely to occur in comparison with methicillin-susceptible <em>S. aureus </em>(95% CI: 3.49 to 7.76).</p><p><strong><em>Conclusion</em></strong>: 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.</p