Prevalence of phenotypic resistance of Staphylococcus aureus isolates to macrolide, lincosamide, streptogramin B, ketolid and linezolid antibiotics in Turkey

Creative Commons License

Adaleti R., Nakipoglu Y., Ceran N., Tasdemir C., Kaya F., Tasdemir S.

BRAZILIAN JOURNAL OF INFECTIOUS DISEASES, vol.14, no.1, pp.11-14, 2010 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 14 Issue: 1
  • Publication Date: 2010
  • Doi Number: 10.1590/s1413-86702010000100003
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.11-14
  • Keywords: Staphylococcus aureus, macrolide, lincosamide, streptogramin B, ketolid, linezolid, MLSB, INDUCIBLE CLINDAMYCIN RESISTANCE, SURVEILLANCE PROGRAM, PROTEIN-SYNTHESIS, INDUCTION
  • Istanbul University Affiliated: No



1. Zelazny AM, Ferraro MJ, Glennen A et al. Selection of Strains for Quality Assessment of the Disk Induction Method for Detection of Inducible Clindamycin Resistance in Staphylococci: a CLSI Collaborative Study. J Clin Microbiol 2005;43(6):2613-5. [ Links ]

2. Fiebelkorn KR, Crawford SA, McElmeel ML, Jorgensen JH. Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulasenegative staphylococci., J Clin Microbiol 2003; 41(10):4740-4. [ Links ]

3. Fokas S, Fokas S, Tsironi M, Kalkani M, Dionysopouloy M. Prevalence of inducible clindamycin resistance in macrolideresistant Staphylococcus spp., Clinical Microbiology and Infection 2005; 11(4):337-40. [ Links ]

4. Davis KA, Crawford SA, Fiebelkorn KR, Jorgensen JH. Selection of Strains for Quality Assessment of the Disk Induction Method for Detection of Inducible Clindamycin Resistance in Staphylococci: a CLSI Collaborative Study, Antimicrob Agents Chemother 2005; 49(7):3059-61. [ Links ]

5. Swaney SM, Aoki H, Ganoza MC, Shinabarger DL. The oxazolidinone linezolid inhibits initiation of protein synthesis in bacteria. Antimicrob Agents Chemother 1998; 42:3251-5. [ Links ]

6. Raad I, Hachem R, Hanna H. Treatment of vancomycin-resistant enterococcal infections in the immunocompromised host: quinupristin-dalfopristin in combination with minocycline. Antimicrob. Agents Chemother 2001; 45:3202-4. [ Links ]

7. Cocito C, Di Giambattista M, Nyssen E, Vannuffel P. Inhibition of protein synthesis by streptogramins and related antibiotics. J Antimicrob Chemother 1997; 39(Suppl A):7-13. [ Links ]

8. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. CLSI approved standard M100-S17. Clinical and Laboratory Standards Institute, 2007; Wayne, PA. [ Links ]

9. Comité de l'antibiogramme de la Société Françasie de Microbiologie 2005 [cited; Available from:] [ Links ].

10. Schmitz FJ, Verhoef J, Fluit AC. Prevalence of resistance to MLS antibiotics in 20 European university hospitals participating in the European SENTRY surveillance programme. Sentry Participants Group. J Antimicrob Chemother. 1999; 43(6):783-92. [ Links ]

11. Aktas Z, Aridogan A, Kayacan CB, Aydin D. Resistance to Macrolide, Lincosamide and Streptogramin Antibiotics in Staphylococci Isolated in Istanbul, Turkey, The Journal of Microbiology 2007; 45(1):286-90. [ Links ]

12. Spiliopoulou I, Petinaki E, Papandreou P, Dimitracopoulos G. erm(C) is the predominant genetic determinant for the expression of resistance to macrolides among methicillin resistant Staphylococcus aureus clinical isolates in Greece. J Antimicrob Chemother 2004;53(5):814-7. [ Links ]

13. Janapatla RP, Yan JJ, Huang AH, Chen HM, Wu HM, Wu JJ. Inducible clindamycin resistance in Staphylococcus aureus isolates causing bacteremia at a university hospital in southern Taiwan, Diagn Microbiol Infect Dis 2007; 58(2):203-9. [ Links ]

14. Otsuka T, Zaraket H, Takano T et al. Macrolide-lincosamidestreptogramin B resistance phenotypes and genotypes among Staphylococcus aureus clinical isolates in Japan, Clin Microbiol Infect 2007; 13(3):325-7. [ Links ]

15. Modak R, Ross D, Kan VL. Macrolide and Clindamycin Resistance in Staphylococcus aureus Isolates and Antibiotic Use in a Veterans Affairs Medical Center, Infect Control Hosp Epidemiol 2008; 29(2):180-2. [ Links ]

16. Merino-Díaz L, Cantos de la Casa A, Torres-Sánchez MJ, Aznar-Martín J. Detection of inducible resistance to clindamycin in cutaneous isolates of Staphylococcus spp. by phenotypic and genotypic methods, Enferm Infecc Microbiol Clin 2007; 25(2):77-81 [ Links ]

17. Lee do K, Kim Y, Park KS, Yang JW, Kim K, Ha NJ. Antimicrobial activity of mupirocin, daptomycin, linezolid, quinupristin-dalfopristin and tigecycline against vancomycin-resistant enterococci (VRE) from clinical isolates in Korea (1998 and 2005). J Biochem Mol Biol 2007; 40(6):881-7. [ Links ]

18. Tsiodras S, Gold HS, Sakoulas G et al. Linezolid resistance in a clinical isolate of Staphylococcus aureus. Lancet 2001; 358(9277), 207-8. [ Links ]

19. Pillai SK, Sakoulas G, Wennersten C et al. Linezolid Resistance in Staphylococcus aureus: Characterization and Stability of Resistant Phenotype.The Journal of Infectious Diseases 2002; 186:1603-7. [ Links ]

20. Jones RN, Fritsche TR, Sader HS, Ross JE. LEADER surveillance program results for 2006: an activity and spectrum analysis of linezolid using clinical isolates from the United States (50 medical centers). Diagn Microbiol Infect Dis 2007; 59(3):309-17. [ Links ]


The incidence of drug-resistant pathogens differs greatly between countries according to differences in the usage of antibiotics. The purpose of this study was to investigate the phenotypic resistance of 321 methicillin resistance Staphylococcus aureus (MRSA) and 195 methicillin susceptible S. aureus (MSSA) in a total of 516 S. aureus strains to macrolide, lincosamide, streptogramin B (MLS(B)), ketolid, and linezolid. Disk diffusion method was applied to determine MLS(B) phenotype and susceptibility to different antibiotic agents. It was found that 54.6% of the isolates were resistant to erythromycin (ERSA), 48% to clindamycin, 55% to azithromycin, 58.7% to spiramycin, 34.7% to telithromycin, and 0.4% to quinupristin-dalfopristin, respectively. No strain resistant to linezolid was found. The prevalence of constitutive (cMLS(B)), inducible (IMLS(B)), and macrolides and type B streptogramins (M/MS(B)) among ERSA isolates (237 MRSA, 45 MSSA) was 69.6 %, 18.2%, and 12.2 % in MRSA and 28.9%, 40%, and 31.1% in MSSA, respectively. In conclusions, the prevalence of cMLS(B) was predominant in MRSA; while in MSSA strains, iMLS(B) and M/MS(B) phenotype were more higher than cMLS(B) phenotype resistance. The resistance to quinupristin-dalfopristin was very low, and linezolid was considered as the most effective antibiotic against all S. aureus strains.