title: Clindamycin resistance among Staphylococcus aureus strains in Israel: implications for empirical treatment of skin and soft tissue infections.
abstract: OBJECTIVE
  The objectives of this study were to characterize isolates of Staphylococcus aureus obtained from skin and soft tissue infections in the community in Israel and to document the sensitivity patterns for commonly used antimicrobial agents.
  
  
  METHODS
  The susceptibilities of S. aureus isolates from skin and soft tissue infections in the community in Israel were reviewed to determine the appropriate empirical therapy for these infections.
  
  
  RESULTS
  A total of 7221 isolates were collected during the period 2009-2012; 39% were from children (age 0-18 years). In children, S. aureus oxacillin resistance dropped from 8.4% to 3.8% (p=0.073). While inducible clindamycin resistance increased slightly from 20% to 25%, there was a prominent increase in constitutive clindamycin resistance from 0.1% to 26.8% (p=0.012). In adults, oxacillin resistance increased from 16% to 23% (p<0.001) and constitutive clindamycin resistance increased notably from 5% to 29% (p<0.001). These findings demonstrate a dramatic increase in clindamycin resistance among S. aureus isolates and suggest against the usage of clindamycin as empirical treatment for suspected S. aureus infections in Israel.
  
  
  CONCLUSIONS
  Beta-lactam anti-staphylococcal agents may be given as empirical treatment for children, but should be considered according to risk factors for adults in Israel.
authors.affiliation: Infectious Diseases Unit, Hilel Yaffe Medical Center, PO Box 169, Hadera, 38100 Israel. Electronic address: michal.stein@gmail.com.
authors.forename: Michal
authors.initials: M
authors.lastname: Stein
authors.affiliation: Pediatric Infectious Diseases Unit, Wolfson Medical Center, Holon, Israel.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Komerska
authors.affiliation: Maccabi Health Services, Israel.
authors.forename: Miriam
authors.initials: M
authors.lastname: Prizade
authors.affiliation: Maccabi Health Services, Israel.
authors.forename: Bracha
authors.initials: B
authors.lastname: Sheinberg
authors.affiliation: Pediatric Infectious Diseases Unit, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Diana
authors.initials: D
authors.lastname: Tasher
authors.affiliation: Pediatric Infectious Diseases Unit, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Somekh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000494:pharmacology / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007557:Israel; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D008875:Middle Aged; D010068:Oxacillin / Q000494:pharmacology / Q000627:therapeutic use; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D010068:Oxacillin
keywords: Clindamycin; Inducible; Resistance; Staphylococcus aureus