1219. Increasing Methicillin Resistance of Staphylococcus lugdunensis in a Tertiary Care Community Hospital in Japan

Abstract Background Staphylococcus lugdunensis, a coagulase-negative staphylococcus, has virulence and pathogenicity similar to that of Staphylococcus aureus. Methicillin resistance and presence of mecA gene are not common in S. lugdunensis in many parts of the world. Recently, higher prevalence of methicillin-resistant S. lugdunensis is reported from Taiwan and Japan. We describe the change in methicillin resistance of S. lugdunensis in a tertiary care community hospital in Sapporo, Japan. Methods We performed a retrospective study of S. lugdunensis, isolated from inpatients and outpatients at our hospital from 2008 to 2017. Rate of methicillin resistance of the first 5 years from 2008 to 2012, and that of the second 5 years from 2013 to 2017 were compared. Risk factors of methicillin resistance were also evaluated. Phenotypic detection of methicillin resistance was identified using broth microdilution by VITEK two system (bioMérieux). Results A total of 369 cases of S. lugdunensis were detected during the study period. Of all cases, 228 (61.8%) were men, and 177 (48.0%) were hospitalized. Twenty-one isolates (5.7%) were positive in blood culture, 216 (58.5%) were positive in cultures of skin and soft tissue. Methicillin-resistant strains were found in 43 (31.6%) of 136 isolates from 2008 to 2012, and in 108 (46.4%) of 233 from 2013 to 2017 (OR 1.87; 95% CI 1.20–2.91; P = 0.006). Of patients with methicillin-resistant S. lugdunensis, 105 cases (69.5%) were hospitalized (P < 0.001). Conclusion In our hospital, methicillin-resistant S. lugdunensis is increasing over the 10 years. Further research is needed to assess trend of methicillin resistance of S. lugdunensis in other healthcare facilities and countries. Disclosures All authors: No reported disclosures.

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Detection of mecA gene by latex agglutination and its molecular analysis by PCR in methicillin resistant staphylococcus aureus.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.07.3752 ◽

2020 ◽

Vol 27 (07) ◽

pp. 1363-1370

Author(s):

Aneela Khawaja ◽

Iffat Javed ◽

Sohaila Mushtaq ◽

Saeed Anwar ◽

Faiqa Arshad ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistance ◽

Meca Gene ◽

Latex Agglutination ◽

Medical Institute ◽

Cross Sectional ◽

Methicillin Resistant ◽

Agglutination Method ◽

Resistant Strains

Antimicrobial resistance (AMR) is a devastating question that is threatening the health globally. The extensive and indiscriminative use of antibiotics has evolved a notorious resistance in Staphylococcus aureus. This resistance developed through possession of mecA gene, which codes for modified penicillin binding protein (PBP2a) and the emergent strain being labeled “methicillin resistant Staphylococcus aureus”. Conventional phenotypic techniques for detection of MRSA rely on standardization of cultural characteristics. The drawbacks of diagnostic error to report MRSA include: poor prognosis, expensive treatment, dissemination of multi-drug resistant strains and even treatment failure. Latex agglutination method can be adopted as a more accurate and quick strategy for rapid detection of methicillin resistance. Objectives: To compare detection of mecA gene in methicillin resistant isolates of Staphylococcus aureus by latex agglutination and PCR; by assessing the sensitivity and specificity of both methods. Study Design: Descriptive Cross-Sectional study. Setting: Pathology Department, Post Graduate Medical Institute, Lahore. Period: From January 2015 to December 2015; according to standard operating procedures at Microbiology laboratory. Material & Methods: A total 713 consecutive, non-duplicate isolates of Staphylococcus aureus were processed. Methicillin resistance was determined using cefoxitin (30mg) by Kirby-Bauer method using CLSI guideline (2016), latex agglutination method; and PCR for mecA gene. Results: The results showed that out of 713 Staphylococcus aureus isolates, 92 (12.90%) isolates were resistant to cefoxitin and were labelled as MRSA. majority MRSA isolates recovered from pus (44.57%) and wound swab (20.65%), followed by blood (13.04%), fluid (8.70%), CSF (4.35%), CVP (3.26%), HVS (3.26%) and tracheal secretion (2.17%). By latex agglutination method, 87 (94.50%) were positive for PBP2a; while on PCR mecA gene was detected only in 82 (89.10%) MRSA isolates. When assessed with PCR (gold standard) the sensitivity and diagnostic accuracy of latex agglutination was 100% and 94.57%, respectively. Conclusion: Latex agglutination test can be employed as rapid and reliable diagnostic technique in MRSA isolates for mecA gene detection, where resources for molecular methods are inadequate. This can effectually lessen the misdiagnosis of resistant strains, and over/ ill-use of antibiotics.

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Ceftaroline resistance in Staphylococcus pseudintermedius gene mecA carriers

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-5680 ◽

2018 ◽

Vol 38 (12) ◽

pp. 2233-2236

Author(s):

Carolina B. Scherer ◽

Larissa S. Botoni ◽

Antônio U. Carvalho ◽

Kelly M. Keller ◽

Adriane P. Costa-Val

Keyword(s):

Methicillin Resistance ◽

Meca Gene ◽

Disk Diffusion ◽

Diffusion Test ◽

Staphylococcus Pseudintermedius ◽

Ceftaroline Fosamil ◽

Disk Diffusion Test ◽

Methicillin Resistant ◽

Resistant Strains ◽

Current Report

ABSTRACT: Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) being a constant concern, ceftaroline fosamil has been recently approved as a new cephalosporin, active against MRSA, for use in humans; only rare cases of resistance have been reported till date. There is no report of resistance to ceftaroline in Staphylococcus pseudintermedius, which is the main bacterium causing dermatitis and otitis in dogs. To evaluate staphylococcal resistance to ceftaroline, 35 isolates of methicillin-resistant S. pseudintermedius (MRSP), carrying the mecA gene, from 26 dogs with folliculitis and nine dogs with external otitis, underwent disk diffusion test with cefoxitin, oxacillin, and ceftaroline. Tests with cefoxitin and oxacillin showed > 90% sensitivity in methicillin resistance detection. In the disk diffusion test, 97.14% (34/35) were resistant to cefoxitin, 94.29% (33/35) to oxacillin, and 31.43% (11/35) to ceftaroline. Of the ceftaroline-resistant strains, 27.27% (3/11) were obtained from the ears of dogs while the rest (8/11) were from the skin. The current report is the first description of MRSP resistance to ceftaroline.

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Methicillin-resistant coagulase-negative staphylococci in healthy dogs

Veterinární Medicína ◽

10.17221/96/2015-vetmed ◽

2017 ◽

Vol 62 (No. 9) ◽

pp. 479-487 ◽

Cited By ~ 4

Author(s):

J. Siugzdaite ◽

A. Gabinaitiene

Keyword(s):

Antimicrobial Resistance ◽

Methicillin Resistance ◽

Meca Gene ◽

Diffusion Method ◽

Coagulase Negative Staphylococcus ◽

Coagulase Negative Staphylococci ◽

Phenotypic Properties ◽

Methicillin Resistant ◽

Healthy Dogs ◽

Resistance Rates

The objective of this study was to evaluate the prevalence of coagulase-negative staphylococci in healthy dogs and to determine whether methicillin-resistant staphylococci expressed the mecA gene. Nasal and rectal swab samples were taken from 50 clinically healthy dogs. The prevalence of coagulase-negative staphylococci was evaluated according to phenotypic properties. The agar diffusion method was applied to evaluate antimicrobial resistance and the prevalence of methicillin resistance was determined using PCR analysing the mecA gene. A total of 59 coagulase-negative staphylococcus strains were isolated from the nostrils and rectums of 37 (74%) clinically healthy dogs. The prevalence of coagulase-negative staphylococci in female dogs was significantly higher compared with male dogs (P < 0.05). The results of antimicrobial susceptibility testing showed that 6.7% of the strains were resistant to oxacillin, 23.7% were resistant to penicillin, 22% to ampicillin and 16.9% to erythromycin. The mecA PCR revealed one oxacillin-sensitive and four oxacillin-resistant coagulase-negative staphylococci strains to be mecA carriers. Staphylococcus sciuri (60%) and Staphylococcus warneri (20%) were the most prevalent species among methicillin-resistant coagulase negative staphylococci. High antimicrobial resistance rates for these bacteria were observed against penicillin (100%), ampicillin (100%), oxacillin (80%), erythromycin (80%) and gentamicin (60%). All strains were susceptible to vancomycin and enrofloxacin. It is assumed that methicillin-resistance genes evolved in coagulase-negative staphylococcus and were then horizontally transferred among staphylococci.

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Detection of Methicillin-Resistant Staphylococcus aureus in Ready-to-Eat Shellfish (Corbiculid heterodont) in Bayelsa State, Nigeria

Microbiology Research Journal International ◽

10.9734/mrji/2020/v30i330202 ◽

2020 ◽

pp. 22-35

Author(s):

Seighazi Regina Egege ◽

Nedie Patience Akani ◽

Chidiebele Emmanuel Ikechukwu Nwankwo

Keyword(s):

Staphylococcus Aureus ◽

Multidrug Resistance ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistance ◽

Meca Gene ◽

Resistance Index ◽

Multidrug Resistant ◽

Coagulase Negative Staphylococcus ◽

Methicillin Resistant ◽

Awareness Campaigns

Aims/Objective: Methicillin-Resistant Staphylococcus aureus (MRSA) is a dominant cause of severe healthcare-associated (HA) infections but has recently emerged as Community-Associated (CA-MRSA) and Livestock-Associated MRSA (LA-MRSA). This study was carried out to detect the presence of Methicillin-Resistant S. aureus in Ready-to-Eat (RTE) Corbiculid heterodont in Bayelsa state, Nigeria. Place of Study: This study was conducted in Yenagoa, Southern Ijaw and Sagbama Local Government Areas, Bayelsa State, Nigeria. Methodology: Fifty-three samples (dried, fried and stewed) of the RTE C. heterodont were collected and subjected to standard microbiological procedures. Results: Seventy Staphylococcus spp. were isolated, consisting of 65 (92.86%) S. aureus and 5 (7.14%) coagulase negative Staphylococcus (CONS). Out of the 65 S. aureus isolates, 53.8% were MRSA. Susceptibility pattern of MRSA showed a decreasing trend of resistance in the order: Amoxacillin, Ampicillin-Cloxacillin, Cefoxitin, and Oxacillin (100%) > Streptomycin (82.9%) >Ceftriaxone (40%) >Cefuroxime (31.4%), > Ciprofloxacin and Trimethoprim-Sulfamethoxazole (17.1%) > Gentamycin and Pefloxacin (8.6%) > Erythromycin (2.9%).Out of the 65 S. aureus isolates, 62 (95.4%) had Multidrug Resistance Index > 0.2 while 3 (4.6%) had 0.2 as their Multidrug Resistance Index. The MRSA isolates were 100% Multidrug Resistant (MDR) while the Methicillin-Sensitive S. aureus (MSSA) were 90% MDR. Molecular characterization of ten S. aureus isolates confirmed 80% S. aureus isolates and 20% CONS (S. sciuri and S. warneri). Polymerase chain reaction (PCR) and Agarose gel-electrophoresis were used to detect the presence of mecA gene, a gene that confers methicillin resistance. The mecA gene with size 500bp was identified in 50% of MRSA. This study reported presence of MRSA and MDR S. aureus in C. heterodont sold in Bayelsa state, Nigeria. This could be the avenue for the spread of MRSA. Public health awareness campaigns should be advocated to enhance hygienic practices in the handling and distribution of food.

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EVALUATION OF THE METHOSD FOR DETECTION METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS.

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2013.5.4 ◽

2013 ◽

pp. 25-31

Author(s):

Thi Kim Chi Nguyen ◽

Dinh Binh Tran ◽

Thi Nam Lien Nguyen ◽

Van Tuan Mai ◽

Godreuil Sylvain

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistance ◽

Meca Gene ◽

Antibiotic Sensitivity ◽

Diffusion Method ◽

Disk Diffusion Method ◽

Antibiotic Resistant ◽

Methicillin Resistant ◽

Resistant Strains

Objective: To evaluate the infections that caused by Methicillin-resistant Staphylococcus aureus and the value of the tests to detect Methicillin-resistant Staphylococcus aureus. Subjects and Methods: Used routine techniques to culture and isolate S.aureus, test the antibiotic sensitivity by Kirby-Bauerr, determination the Methicillin-resistant Staphylococcus aureus by Oxacillin and cefoxitin disc and PCR in identified the mecA gene Staphylococcus aureus. Results: The rate of Staphylococcus aureus isolated is highest which isolated from pus specimens (55.06%). In 267 strains of Staphylococcus aureus isolated in the Department of Microbiology, Hue Central Hospital the Methicillin resistance Staphylococcus aureus was 61.42%. The level of antibiotic resistant strains of Methicillin-resistant Staphylococcus aureus is higher than that in Methicillin-sensitive strains. Conclusion: Cefoxitin 30 microg disk diffusion method to detect Methicillin resistance is effective for determinate Methicillin-resistant Staphylococcus aureus (sensitivity and specificity are all 100.00%). Key words: Staphylococcus aureus Methicillin-resistant.

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Antibiotic Resistance Profile and Biofilm Production of Staphylococcus pseudintermedius Isolated from Dogs in Thailand

Pharmaceuticals ◽

10.3390/ph14060592 ◽

2021 ◽

Vol 14 (6) ◽

pp. 592

Author(s):

Pavarish Jantorn ◽

Hawaree Heemmamad ◽

Tanawan Soimala ◽

Saowakon Indoung ◽

Jongkon Saising ◽

...

Keyword(s):

Antibiotic Resistance ◽

Meca Gene ◽

Staphylococcus Pseudintermedius ◽

Methicillin Resistant ◽

Antibiotic Resistance Profile ◽

Biofilm Production ◽

Southern Thailand ◽

Life Threatening ◽

Suitable Treatment ◽

Resistant Strains

Staphylococcus pseudintermedius is a zoonotic pathogen that can cause life-threatening infections in animals and humans. The study of methicillin-resistant S. pseudintermedius (MRSP) and its ability to produce biofilms is important to select the most suitable treatment. The prevalence and characteristics of S. pseudintermedius isolated from dogs admitted at the Veterinary Teaching Hospital, Prince of Songkla University, Thailand were assessed. Results showed that 28.30% (15/53) of the isolates were MRSP. Amplification of the mecA gene was observed in 93.33% (14/15) MRSP. Methicillin-resistant strains revealed co-resistant patterns against other antibiotics, including chloramphenicol, clindamycin, tetracycline, clarithromycin, ciprofloxacin, and trimethoprim. In this study, all bacterial isolates produced biofilms, while 90.55% of S. pseudintermedius isolates were strong or moderate biofilm producers. Most (45–60%) of the resistant strains were strong biofilm producers, while the correlation between biofilm production and antibiotic resistance was not statistically significant. This is the first study in southern Thailand to investigate the drug-resistant profile of S. pseudintermedius and its ability to form biofilm. The results will contribute to a better understanding of the emergence and prevalence of antimicrobial resistance in S. pseudintermedius.

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The Prevalence and Antimicrobial Susceptibility Pattern of Gram-Positive Pathogens: Three-Year Study at a Private Tertiary Care Hospital in Mumbai, India

Journal of Laboratory Physicians ◽

10.1055/s-0041-1731136 ◽

2021 ◽

Author(s):

Sweta Shah ◽

Ritika Rampal ◽

Pooja Thakkar ◽

Sushima Poojary ◽

Shweta Ladi

Keyword(s):

Antimicrobial Susceptibility ◽

Tertiary Care Hospital ◽

Methicillin Resistance ◽

Tertiary Care ◽

Resistance Pattern ◽

Steady Increase ◽

Coagulase Negative Staphylococcus ◽

Care Hospital ◽

Gram Positive ◽

Tract Infections

Abstract Introduction The growing resistance pattern of the gram-positive pathogens along with a steady increase in minimum inhibitory concentration of the currently available antibiotics have led to an increase in morbidity and mortality rates in India. This study aims to access the shifting antibiotic susceptibility paradigm of the gram-positive pathogens in various infections at a tertiary care center. Methods This is a 3-year retrospective observational study which was performed from January 2016 to December 2018 at a tertiary care hospital in Mumbai. All clinically significant gram-positive cocci isolated from a variety of clinical specimens were studied for their prevalence and antimicrobial susceptibility. Results Out of 4,428 gram-positive isolates, Staphylococcus aureus (35.3%) was the commonly encountered pathogen, followed by Enterococcus spp. (32.1%) and coagulase-negative Staphylococcus (CoNS) (25.7%). S. aureus was majorly isolated from skin and soft tissue infections (60.3%), followed by patients with respiratory tract infections (18.2%) and blood stream infections (13%). Among S. aureus, particularly methicillin-resistant S.aureus (MRSA), prevalence increased from 29.5% in 2016 to 35.1% in 2018, with an overall prevalence of 33.6%. All S. aureus isolates were 100% sensitive toward vancomycin, linezolid, tigecycline, and teicoplanin. However, the CoNS isolates showed a higher resistance rate with reduced susceptibility toward linezolid and teicoplanin. High prevalence of resistance was observed across gram-positive isolates with commonly used antibiotics such as ciprofloxacin, levofloxacin, and erythromycin. While the prevalence of linezolid-resistant enterococcus (LRE) was 3.6%, vancomycin (VRE) and teicoplanin resistance among the enterococcus species was as high as 7.7% and 7.5%, respectively. Conclusion Rising methicillin resistance among the Staphylococcal species (MRSA and MR-CoNS) along with reduced susceptibility toward currently available anti-MRSA agents is a matter of serious concern as it limits the therapeutic options for treating multidrug resistant (MDR) gram-positive infections.

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Multiple Antimicrobial Resistance in Methicillin-Resistant Staphylococcus sciuri Group Isolates from Wild Ungulates in Spain

Antibiotics ◽

10.3390/antibiotics10080920 ◽

2021 ◽

Vol 10 (8) ◽

pp. 920

Author(s):

Joaquín Rey Pérez ◽

Laura Zálama Rosa ◽

Alfredo García Sánchez ◽

Javier Hermoso de Mendoza Salcedo ◽

Juan Manuel Alonso Rodríguez ◽

...

Keyword(s):

Cervus Elaphus ◽

Methicillin Resistance ◽

Bacterial Species ◽

Sccmec Type ◽

Meca Gene ◽

Domestic Animal ◽

Wild Ungulates ◽

Methicillin Resistant ◽

Phenotypic Resistance ◽

Columbia Blood Agar

The aim of this study was to investigate the presence of methicillin-resistant Staphylococcus (MRS) strains in non-managed wild ungulates present in a typical Mediterranean forest in Spain. For this purpose, nasal swabs were obtained from 139 animals: 90 wild boar (Sus scrofa), 42 red deer (Cervus elaphus) and 7 fallow deer (Dama dama), which were subsequently pre-enriched in BHI+ NaCl (6.5%) (24 h/37 °C), and then seeded in Columbia blood agar (24 h/37 °C)). The presence of the mecA gene was investigated by PCR, first from the confluent and then from individual colonies. A total of 10 mecA+ colonies were obtained of which only seven showed phenotypic resistance to oxacillin/cefoxitin (methicillin resistance). All MRS strains belonged to the Staphylococcus sciuri group. Methicillin-resistant Staphylococcus aureus (MRSA) was not detected. In addition, a significant number of MRS strains showed resistance to other antimicrobials, mainly β-lactam (7/7), gentamicin (7/7), fusidic acid (6/7) and quinupristin–dalfopristin (6/7), showing an irregular correlation with their coding genes. The genetic profiles grouped the seven strains obtained according to the bacterial species but not in relation to the animal source or the geographical place of origin. The presence of SCCmec type III, common to animals and humans, has been detected in three of the strains obtained. In conclusion, the study reveals that the wild ungulates investigated play a role as potential reservoirs of multi-resistant strains of MRS. Such strains, due to their characteristics, can be easily transferred to other wild or domestic animal species and ultimately to humans through their products.

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Distribution of MR-CoNS in the clinical staffs of tertiary care hospital

IP International Journal of Medical Microbiology and Tropical Diseases ◽

10.18231/j.ijmmtd.2021.022 ◽

2021 ◽

Vol 7 (2) ◽

pp. 100-102

Author(s):

Sonu S. Ahirwar ◽

Prabhat Jatav ◽

Kirti Kushwaha

Keyword(s):

Low Income ◽

Nasal Swab ◽

Tertiary Care Hospital ◽

Methicillin Resistance ◽

Tertiary Care ◽

Automated System ◽

Diffusion Method ◽

Care Hospital ◽

Methicillin Resistant ◽

Vitek 2

Methicillin-resistant coagulase-negative staphylococci (MR-CoNS) associated infection is a growing concern in healthcare settings now a day. MR-CoNS are the main infectious agents of the hospital acquired infection. Clinical staffs to patients transmission of resistant strains have caused a rapid increase in the prevalence of antimicrobial resistance in recent years. Growing rate of antimicrobial resistant against available antibiotics of MR-CoNS is a developing problem in low income or lower middle income counties. This study was conducted to determine the occurrence MR-CoNS isolated from different clinical staffs of tertiary care hospital. This prospective study conducted in clinical staffs, nasal swab were collected from all the participants. Screening of CoNS were done on the basis of cultural, morphological and biochemical tests, identification and AST analysis done by VITEK-2 automated system. Methicillin resistance pattern was checked by VITEK-2 and Kirby-Bauer disc diffusion method according to CLSI guideline. A total of 129 nasal swab samples were collected from clinical staffs, of which n=81 isolates (85.6%) were CoNS. Among n=81 CoNS, (48.12%) , (41.97%) , (7.4%) and (2.4%) were reported. Out of n=81 CoNS isolates, n=26 were conformed as MR-CoNS. Maximum methicillin resistance were reported in 53.48% (14/26), 42.30% (11/26), 3.84% (1/26) and 0% (0/26). Theoccurrence rate of MR-CoNS are higher (20.6%) in the healthcare workers and most of the methicillin resistant-CoNS isolates shows high level of resistance against widely used antibiotics but all the isolates susceptible against vancomycin.

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Inducible Clindamycin Resistance and Biofilm Production among Staphylococci Isolated from Tertiary Care Hospitals in Nepal

Infectious Disease Reports ◽

10.3390/idr13040095 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1043-1052

Author(s):

Sarita Manandhar ◽

Raju Shrestha ◽

Ratna Shova Tuladhar ◽

Sunil Lekhak

Keyword(s):

Tissue Culture ◽

Biofilm Formation ◽

Tertiary Care ◽

Plate Method ◽

Methicillin Resistant ◽

Inducible Clindamycin Resistance ◽

Biofilm Production ◽

Resistant Strains ◽

Tissue Culture Plate ◽

Tertiary Care Hospitals

Resistance to antibiotics, biofilm formation and the presence of virulence factors play important roles in increased mortality associated with infection by staphylococci. The macrolide lincosamide streptogramin B (MLSB) family of antibiotics is commonly used to treat infections by methicillin-resistant isolates. Clinical failure of clindamycin therapy has been reported due to multiple mechanisms that confer resistance to MLSB. This study aims to find the incidence of different phenotypes of MLSB resistance and biofilm production among staphylococci. A total of 375 staphylococci were isolated from different clinical samples, received from two tertiary care hospitals in Nepal. Methicillin resistance was detected by cefoxitin disc diffusion method and inducible clindamycin resistance by D test, according to CLSI guidelines. Biofilm formation was detected by the tissue culture plate method and PCR was used to detect ica genes. Of the total staphylococci isolates, 161 (42.9%) were Staphylococcus aureus, with 131 (81.4%) methicillin-resistant strains, and 214 (57.1%) isolates were coagulase-negative staphylococci, with 143 (66.8%) methicillin-resistant strains. The overall prevalence of constitutive MLSB (cMLSB) and inducible MLSB (iMLSB) phenotypes was 77 (20.5%) and 87 (23.2%), respectively. Both iMLSB and cMLSB phenotypes predominated in methicillin-resistant isolates. The tissue culture plate method detected biofilm formation in 174 (46.4%) isolates and ica genes in 86 (22.9%) isolates. Among biofilm producing isolates, cMLSB and iMLSB phenotypes were 35 (20.1%) and 27 (15.5%), respectively. The cMLSB and iMLSB were 11 (12.8%) and 19 (22.1%), respectively, in isolates possessing ica genes. Clindamycin resistance in the form of cMLSB and iMLSB, especially among MRSA, emphasizes the need for routine D tests to be performed in the lab.

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