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Antimicrobial Agents and Chemotherapy, June 2005, p. 2283-2288, Vol. 49, No. 6
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.6.2283-2288.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Inducible Clindamycin Resistance and Molecular Epidemiologic Trends of Pediatric Community-Acquired Methicillin-Resistant Staphylococcus aureus in Dallas, Texas

Susana Chavez-Bueno,1* Bülent Bozdogan,2,{dagger} Kathy Katz,1 Karen L. Bowlware,1,{ddagger} Nancy Cushion,1 Dominick Cavuoti,3 Naveed Ahmad,3 George H. McCracken Jr.,1 and Peter C. Appelbaum2

University of Texas Southwestern Medical Center of Dallas,1 Children's Medical Center of Dallas, Dallas, Texas 75390,3 Hershey Medical Center, Hershey, Pennsylvania 170332

Received 21 October 2004/ Returned for modification 26 December 2004/ Accepted 30 January 2005

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection occurs commonly in children. Clindamycin resistance may be inducible or constitutive, and the rates of inducible resistance in CA-MRSA that could produce clindamycin treatment failures vary worldwide. The double-disk test was performed in 197 erythromycin-resistant and clindamycin-susceptible CA-MRSA strains from children in Dallas, Texas, from 1999 to 2002 to determine inducible clindamycin resistance. Resistance mechanisms were studied by PCR; epidemiologic trends were studied by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Inducible resistance was demonstrated in 28 (93% ±6%) of 30 tested isolates in 1999, 21 (64%, ±11%) of 33 in 2000, 12 (23% ±7%) of 52 in 2001, and 6 (7% ±3%) of 82 in 2002. All noninducible strains had the msr(A) gene. Among inducible resistant strains, 31 had erm(B), 24 had erm(C), and 12 had erm(A) genes. Two distinct pulsed types were the most prevalent; one of them was the most common pulsed type in 1999, whereas in 2002 a different pulsed type was prevalent. MLST analyses determined that ST-8 was the most common type, with 76% ±5% found in 2002. All but one of these clindamycin-susceptible, erythromycin-resistant ST-8 strains showed no induction of clindamycin resistance. We conclude that, among erythromycin-resistant, clindamycin-susceptible CA-MRSA strains isolated from children in Dallas, inducible methylase resistance became less common from 1999 to 2002 (P < 0.001). The phenotype of strains was associated with their sequence type. Our results demonstrate a clonal shift in CA-MRSA in Dallas children from 1999 to 2002.

* Corresponding author. Mailing address: 5323 Harry Hines Boulevard, Dallas, Texas 75390-9063. Phone: (214) 648-3720. Fax: (214) 648-2961. E-mail: Susana.Chavez-Bueno{at}UTSouthwestern.edu.

{dagger} Present address: Institut Pasteur, 75015 Paris, France.

{ddagger} Present address: University of Oklahoma, Health Sciences Center, Oklahoma City, OK 73104.

Antimicrobial Agents and Chemotherapy, June 2005, p. 2283-2288, Vol. 49, No. 6
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.6.2283-2288.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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