Inducible Clindamycin and Methicillin Resistant Staphylococcus aureus Among Cancer Patients at University of Gondar Compressive Specialized Hospital, Northwest Ethiopia: Carriage Rate and Antibiotic Resistance Patterns

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a type of Staphylococcus aureus strain which is resistant to a group of beta-lactam antibiotics. Methicillin-resistance is due to a penicillin-binding protein, which has a low affinity for beta-lactam antibiotics. Excess and inappropriate use of clindamycin have led to the emergence of resistant Staphylococcal strains. Cancer patients are at high risk of bacterial colonization due to cancer chemotherapy which leads to severe and prolonged immunosuppression. This study aimed to assess the carriage rate of inducible clindamycin and MRSA among cancer patients.

Methods: A hospital-based cross-sectional study was conducted on 200 cancer patients from January to August 2019. Sociodemographic data and nasal swab samples were collected and inoculated on mannitol salt agar and then incubated at 37°C for 24 hours. The identification of isolates was done by colony characteristics and biochemical reactions. MRSA was detected using cefoxitin disc and inducible clindamycin resistance detected using D-test. Interpretations of antibiotics susceptibility was done using CLSI 2018. Finally, data was entered, cleared, and checked using Epi-info version 7 and exported to SPSS version 20 for analysis. Logistic regression was used for statistical association. p-value ≤ 0.05 at 95% CI was considered statistically significant.

Results: In this study, of the 59 Staphylococcus aureus isolates tested, 22% (13/59) were MRSA and 78% (46/59) were MSSA. MRSA carriage rate in females was 18.6% (11/59) whereas in males it was 3.4% (2/59). MRSA carriage among urban residents (15.3% (9/59)) was higher than their rural counterparts (6.8% (4/59)). The prevalence of inducible clindamycin resistance was 17% (10/59). Multi-drug resistance patterns among Staphylococcus aureus isolates was 55.9% (33/59). Clindamycin (84.6%), chloramphenicol (84.6%), and ciprofloxacin (69.2%) were the most effective whereas penicillin (100%), tetracycline (76.9%), and erythromycin (76.9%) were the least effective for MRSA isolates. Urban living, being illiterate, being employed, patients with liver and lung cancer were significantly associated with MRSA carriage.

Conclusions: This study showed high rates of MRSA carriage and inducible clindamycin resistance with the percentages of 22 and 17, respectively. Therefore, decolonization of MRSA carriers and rational usage of antibiotics should be implemented.