title: Healthcare-Associated Methicillin-Resistant Staphylococcus aureus: Clinical characteristics and antibiotic resistance profile with emphasis on macrolide-lincosamide-streptogramin B resistance.
abstract: OBJECTIVE
  Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen worldwide and its multidrug resistance is a major concern. This study aimed to determine the clinical characteristics and antibiotic susceptibility profile of healthcare-associated MRSA with emphasis on resistance to macrolide-lincosamide-streptogramin B (MLSB) phenotypes and vancomycin.
  
  
  METHODS
  This cross-sectional study was carried out between February 2014 and February 2015 across four tertiary care hospitals in Mangalore, South India. Healthcare-associated infections among 291 inpatients at these hospitals were identified according to the Centers for Disease Control and Prevention guidelines. Clinical specimens were collected based on infection type. S. aureus and MRSA isolates were identified and antibiotic susceptibility tests performed using the Kirby-Bauer disk diffusion method. The minimum inhibitory concentration of vancomycin was determined using the Agar dilution method and inducible clindamycin resistance was detected with a double-disk diffusion test (D-test).
  
  
  RESULTS
  Out of 291 healthcare-associated S. aureus cases, 88 were MRSA (30.2%). Of these, 54.6% were skin and soft tissue infections. All of the isolates were susceptible to teicoplanin and linezolid. Four MRSA isolates exhibited intermediate resistance to vancomycin (4.6%). Of the MRSA strains, 10 (11.4%) were constitutive MLSB phenotypes, 31 (35.2%) were inducible MLSB phenotypes and 14 (15.9%) were macrolide-streptogramin B phenotypes.
  
  
  CONCLUSIONS
  Healthcare-associated MRSA multidrug resistance was alarmingly high. In routine antibiotic susceptibility testing, a D-test should always be performed if an isolate is resistant to erythromycin but susceptible to clindamycin. Determination of the minimum inhibitory concentration of vancomycin is necessary when treating patients with MRSA infections.
authors.affiliation: Departments of Microbiology, Kasturba Medical College, Mangalore, India.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Kumari
authors.affiliation: Departments of Microbiology, Kasturba Medical College, Mangalore, India.
authors.forename: Shalini M
authors.initials: SM
authors.lastname: Shenoy
authors.affiliation: Departments of Microbiology, Kasturba Medical College, Mangalore, India.
authors.forename: Shrikala
authors.initials: S
authors.lastname: Baliga
authors.affiliation: Medicine, Kasturba Medical College, Mangalore, India.
authors.forename: M
authors.initials: M
authors.lastname: Chakrapani
authors.affiliation: Departments of Microbiology, Kasturba Medical College, Mangalore, India.
authors.forename: Gopalkrishna K
authors.initials: GK
authors.lastname: Bhat
keywords: Antibiotic Resistance; Clindamycin; Healthcare Associated Infections; Methicillin-Resistant Staphylococcus aureus; Phenotypes; Vancomycin