Collaborative evaluation of an erythromycin-clindamycin combination well for detection of inducible clindamycin resistance in beta-hemolytic streptococci by use of the CLSI broth microdilution method

James H. Jorgensen, M. Leticia McElmeel, Letitia C. Fulcher, Lesley McGee, Sandra S. Richter, K. P. Heilmann, Mary Jane Ferraro, Jean Spargo, Anita Glennen

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Abstract

Constitutive or inducible clindamycin resistance can occur in beta-hemolytic streptococci due to the presence of an erm gene. The Clinical and Laboratory Standards Institute (CLSI) has recommended a disk approximation test (D-zone test) with erythromycin and clindamycin disks and a single-well broth test combining erythromycin and clindamycin for detection of inducible clindamycin resistance in staphylococci, but only a disk approximation test for the beta-hemolytic streptococci. This collaborative study assessed two different erythromycin and clindamycin concentration combinations in single wells (1 μg/ml + 0.25 μg/ml [erythromycin plus clindamycin] and 1 μg/ml + 0.5 μg/ml) with three different brands of Mueller-Hinton broth supplemented with 3% lysed horse blood for testing of frozen panels prepared for this study. All labs performed the D-zone test as described by the CLSI. A total of 155 nonduplicate streptococcal isolates (50 group A, 48 group B, 28 group C, and 29 group G isolates) were tested; 99 isolates showed inducible resistance by the D-zone test. There were some differences noted based upon the test medium. The sensitivity of the erythromycin plus clindamycin combination of 1 μg/ml + 0.25 μg/ml was 91 to 100%, while the sensitivity of the combination of 1 μg/ml + 0.5 μg/ml was 95 to 100%. Specificity overall was 98%. The slightly higher sensitivity of the combination of 1 μg/ml + 0.5 μg/ml is recommended. This study has demonstrated that a single-well microdilution test incorporating erythromycin and clindamycin in combination is a sensitive and specific indicator of inducible clindamycin resistance and could be included in routine test panels.

Original languageEnglish (US)
Pages (from-to)2884-2886
Number of pages3
JournalJournal of Clinical Microbiology
Volume49
Issue number8
DOIs
StatePublished - Aug 2011

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Clindamycin
Erythromycin
Streptococcus
Staphylococcus
Horses

ASJC Scopus subject areas

  • Microbiology (medical)

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Collaborative evaluation of an erythromycin-clindamycin combination well for detection of inducible clindamycin resistance in beta-hemolytic streptococci by use of the CLSI broth microdilution method. / Jorgensen, James H.; McElmeel, M. Leticia; Fulcher, Letitia C.; McGee, Lesley; Richter, Sandra S.; Heilmann, K. P.; Ferraro, Mary Jane; Spargo, Jean; Glennen, Anita.

In: Journal of Clinical Microbiology, Vol. 49, No. 8, 08.2011, p. 2884-2886.

Research output: Contribution to journalArticle

Jorgensen, James H. ; McElmeel, M. Leticia ; Fulcher, Letitia C. ; McGee, Lesley ; Richter, Sandra S. ; Heilmann, K. P. ; Ferraro, Mary Jane ; Spargo, Jean ; Glennen, Anita. / Collaborative evaluation of an erythromycin-clindamycin combination well for detection of inducible clindamycin resistance in beta-hemolytic streptococci by use of the CLSI broth microdilution method. In: Journal of Clinical Microbiology. 2011 ; Vol. 49, No. 8. pp. 2884-2886.
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abstract = "Constitutive or inducible clindamycin resistance can occur in beta-hemolytic streptococci due to the presence of an erm gene. The Clinical and Laboratory Standards Institute (CLSI) has recommended a disk approximation test (D-zone test) with erythromycin and clindamycin disks and a single-well broth test combining erythromycin and clindamycin for detection of inducible clindamycin resistance in staphylococci, but only a disk approximation test for the beta-hemolytic streptococci. This collaborative study assessed two different erythromycin and clindamycin concentration combinations in single wells (1 μg/ml + 0.25 μg/ml [erythromycin plus clindamycin] and 1 μg/ml + 0.5 μg/ml) with three different brands of Mueller-Hinton broth supplemented with 3{\%} lysed horse blood for testing of frozen panels prepared for this study. All labs performed the D-zone test as described by the CLSI. A total of 155 nonduplicate streptococcal isolates (50 group A, 48 group B, 28 group C, and 29 group G isolates) were tested; 99 isolates showed inducible resistance by the D-zone test. There were some differences noted based upon the test medium. The sensitivity of the erythromycin plus clindamycin combination of 1 μg/ml + 0.25 μg/ml was 91 to 100{\%}, while the sensitivity of the combination of 1 μg/ml + 0.5 μg/ml was 95 to 100{\%}. Specificity overall was 98{\%}. The slightly higher sensitivity of the combination of 1 μg/ml + 0.5 μg/ml is recommended. This study has demonstrated that a single-well microdilution test incorporating erythromycin and clindamycin in combination is a sensitive and specific indicator of inducible clindamycin resistance and could be included in routine test panels.",
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