Detection of various types of resistance patterns and their correlation with minimal inhibitory concentrations against clindamycin among methicillin-resistant Staphylococcus aureus isolates.

Purpose: The macrolide lincosamide streptogramin B (MLS B ) family of antibiotics serves as an alternative for the treatment of skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA). However, resistance to clindamycin too has emerged, which is of two types, inducible and constitutive. Therapeutic failure is common with inducible type of clindamycin resistance. This study was done to determine the various clindamycin resistance patterns in MRSA isolates and to compare them with minimal inhibitory concentration (MIC) of clindamycin. Materials and Methods: Fifty MRSA isolates were studied by disc approximation test (D test) to detect inducible iMLS B resistance and MIC by agar dilution technique. Results: Of the 50 isolates, 34 were sensitive to both clindamycin and erythromycin. 16 isolates showed different sensitivity patterns; nine of these were positive for D zone indicating inducible iMLS B resistance, five were positive for constitutive MLS B resistance and two showed possible efflux mechanism for macrolide resistance. Out of the 34 sensitive isolates, 5 showed isolated colonies (subpopulation) inside the clindamycin-sensitive zone. When these sub-populations were tested further, two were constitutive MLS B phenotypes, two were inducible iMLS B and one was HD (hazy D zone), which is D + with growth up to clindamycin disc (which is also considered as constitutive MLS B phenotype). Seven isolates showed an MIC of ≥4 μg/ml to clindamycin in spite of being susceptible to both erythromycin and clindamycin by Kirby Bauer disc diffusion technique. Out of these seven isolates, five were those which grew as subpopulation inside the clindamycin-sensitive zone. Conclusion: Detection of iMLS B resistance among MRSA helps to avoid treatment failure with clindamycin. Studying the subpopulation inside the clindamycin-sensitive zone raises the question of existence of hetero-resistance or some other mechanism, which needs further study.

Thyroid abscess due to Scedosporium apiospermum.

We report a case of thyroid abscess caused by Scedosporium apiospermum in a patient with cirrhosis of liver and autoimmune haemolytic anaemia. To date, there are no reports of isolation of this fungus from thyroid abscess.

Bilateral renal angiomyolipoma in association with tuberous sclerosis.

Renal angiomyolipoma with tuberous sclerosis has not yet been reported in Indian literature. We report a case of bilateral angiomyolipoma associated with tuberous sclerosis in a 25 year old man.