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Mechanisms of Resistance

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

Susana Chavez-Bueno, Bülent Bozdogan, Kathy Katz, Karen L. Bowlware, Nancy Cushion, Dominick Cavuoti, Naveed Ahmad, George H. McCracken Jr., Peter C. Appelbaum
Susana Chavez-Bueno
1University of Texas Southwestern Medical Center of Dallas
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  • For correspondence: Susana.Chavez-Bueno@UTSouthwestern.edu
Bülent Bozdogan
2Hershey Medical Center, Hershey, Pennsylvania 17033
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Kathy Katz
1University of Texas Southwestern Medical Center of Dallas
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Karen L. Bowlware
1University of Texas Southwestern Medical Center of Dallas
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Nancy Cushion
1University of Texas Southwestern Medical Center of Dallas
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Dominick Cavuoti
3Children's Medical Center of Dallas, Dallas, Texas 75390
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Naveed Ahmad
3Children's Medical Center of Dallas, Dallas, Texas 75390
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George H. McCracken Jr.
1University of Texas Southwestern Medical Center of Dallas
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Peter C. Appelbaum
2Hershey Medical Center, Hershey, Pennsylvania 17033
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DOI: 10.1128/AAC.49.6.2283-2288.2005
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ABSTRACT

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.

  • Copyright © 2005 American Society for Microbiology
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Inducible Clindamycin Resistance and Molecular Epidemiologic Trends of Pediatric Community-Acquired Methicillin-Resistant Staphylococcus aureus in Dallas, Texas
Susana Chavez-Bueno, Bülent Bozdogan, Kathy Katz, Karen L. Bowlware, Nancy Cushion, Dominick Cavuoti, Naveed Ahmad, George H. McCracken Jr., Peter C. Appelbaum
Antimicrobial Agents and Chemotherapy May 2005, 49 (6) 2283-2288; DOI: 10.1128/AAC.49.6.2283-2288.2005

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Inducible Clindamycin Resistance and Molecular Epidemiologic Trends of Pediatric Community-Acquired Methicillin-Resistant Staphylococcus aureus in Dallas, Texas
Susana Chavez-Bueno, Bülent Bozdogan, Kathy Katz, Karen L. Bowlware, Nancy Cushion, Dominick Cavuoti, Naveed Ahmad, George H. McCracken Jr., Peter C. Appelbaum
Antimicrobial Agents and Chemotherapy May 2005, 49 (6) 2283-2288; DOI: 10.1128/AAC.49.6.2283-2288.2005
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KEYWORDS

Anti-Bacterial Agents
clindamycin
community-acquired infections
Drug Resistance, Bacterial
methicillin resistance
staphylococcal infections
Staphylococcus aureus

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