: Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) differentiated by degree of skin detachment. Common triggers include anticonvulsants, sulfonamides, antibiotics (penicillin, cephalosporin, quinolones) and acetaminophen. Reports of clindamycin causing cutaneous complications are rare with only 6 published reports, none of which were reported in the Philippines. Though uncommon, it is an important consideration in patients presenting with erythematous to violaceous purpuric macules that progress to full thickness epidermal exfoliation. : A 59-year-old female who presented with erythematous maculopapular rash on both hands, dry crusted lesions on the mouth and positive Nikolsky sign within 28 days of administration of Clindamycin. Algorithm for assessment of drug causality in SJS and TENS (ALDEN) was done and Clindamycin scored 6 points, which points to a definite drug causality of SJS/TEN. : A female in her late 50s presented with fatigue, malaise, and sore throat. Initially managed as a case of sepsis peritonsillar abscess right but later in the course of admission, presented with erythematous maculopapular rash on both hands and dry crusted lesions on the mouth. Patient was clinically diagnosed with Steven-Johnson syndrome and toxic epidermal syndrome and was given a course of intravenous hydrocortisone. Patient unfortunately expired due to overwhelming sepsis. Severe cutaneous adverse reaction induced by clindamycin are rare but important life-threatening conditions which needs prompt recognition and treatment. SJS/TEN as a secondary diagnosis leads to a delay in management, therefore a high index of suspicion and the utility of validated scoring tools should be maintained throughout the course of treatment.
Clindamycin

No abstract available.
Animals ; Babesiosis* ; Clindamycin ; Humans ; Male* ; Quinine

No abstract available.
Animals ; Babesiosis* ; Clindamycin ; Humans ; Male* ; Quinine

BACKGROUND: The Clinical and Laboratory Standards Institute (CLSI) recommends testing for inducible clindamycin resistance in clindamycin non-resistant and erythromycin resistant (CNR-ER) staphylococci by using a D-zone test. Recently, the VITEK2 system was developed to detect inducible clindamycin resistance in staphylococci. We evaluated the performance of the VITEK2 system by comparing it with a D-zone test. METHODS: In detecting inducible clindamycin resistance, a total of 142 clinical isolates of staphylococci were tested by using the VITEK2 Antimicrobial Susceptibility Test (AST)-P601 card (bioMerieux, Marcy l'Etoile, France) and the D-zone test. Of the 142 isolates of staphylococci tested, 114 were CNR-ER staphylococci [40 coagulase-negative staphylococci (CoNS), 74 Staphylococcus aureus] and 28 were staphylococci, either resistant or susceptible to clindamycin and erythromycin (1 CoNS and 27 S. aureus). RESULTS: Of the 114 CNR-ER staphylococci, 98.6% (73/74) of S. aureus and 32.5% (13/40) of CoNS were inducible clindamycin resistant according to the Dzone test. Overall sensitivity and specificity of the VITEK2 system were 98.8% (85/86) and 98.2% (55/56) respectively, and the agreement between the VITEK2 system and the D-zone test was 98.6% (140/142). CONCLUSION: The VITEK2 system shows high concordance with a D-zone test. The inducible clindamycin resistance in staphylococci can be detected easily and conveniently by the VITEK2 system.
Clindamycin ; Erythromycin ; Sensitivity and Specificity ; Staphylococcus ; Staphylococcus aureus

BACKGROUND: The erythromycin-resistance rate and phenotype distribution of Streptococcus propenes are quite different by geographical variation and study period. The aim of the present study was to determine the evolution of resistance to erythromycin and the frequency of erythromycin resistance phenotype of S. pyogenes isolated from Wonju Christian Hospital. METHODS: The minimal inhibitory concentrations (MICs) of erythromycin and clindamycin for 94 S. pyogenes isolated from clinical specimens between 1990 to 1998 were investigated. Double disk test of erythromycin (78microgram) and clindamycin (25microgram) were performed for 15 isolates of erythromycin resistant S. pyogenes to evaluate the erythromycin resistance phenotype. RESULTS: The resistance rates of 94 isolates of S. pyogenes were 16%(15/94) to erythromycin and 4%(4/94) to clindamycin. The frequency of erythromycin resistance phenotype in decreasing order were M phenotype (47%), inducible resistance phenotype (40%), and constitutive resistance phenotype (13%). Erythromycin-resistant S. pyogenes did not exist until 1993, but was isolated since 1994, and ranged from 14.0% to 24.0% during the period of 1994-1998. CONCLUSIONS: Our finding documents the emergence of high resistance rates to erythromycin in S. pyogenes at Wonju area since 1994. The M phenotype (47%) and inducible resistance phenotype (40%) account for the majority of erythromycin-resistant S. pyogenes.
Clindamycin ; Erythromycin* ; Gangwon-do ; Phenotype* ; Streptococcus pyogenes* ; Streptococcus*

BACKGROUND: Periodic monitoring of regional or institutional resistance trends of clinically important anaerobic bacteria is recommended, because the resistance of anaerobic pathogens to antimicrobial drugs and inappropriate therapy are associated with poor clinical outcomes. There has been no multicenter study of clinical anaerobic isolates in Korea. We aimed to determine the antimicrobial resistance patterns of clinically important anaerobes at multiple centers in Korea. METHODS: A total of 268 non-duplicated clinical isolates of anaerobic bacteria were collected from four large medical centers in Korea in 2012. Antimicrobial susceptibility was tested by the agar dilution method according to the CLSI guidelines. The following antimicrobials were tested: piperacillin, piperacillin-tazobactam, cefoxitin, cefotetan, imipenem, meropenem, clindamycin, moxifloxacin, chloramphenicol, metronidazole, and tigecycline. RESULTS: Organisms of the Bacteroides fragilis group were highly susceptible to piperacillin-tazobactam, imipenem, and meropenem, as their resistance rates to these three antimicrobials were lower than 6%. For B. fragilis group isolates and anaerobic gram-positive cocci, the resistance rates to moxifloxacin were 12-25% and 11-13%, respectively. Among B. fragilis group organisms, the resistance rates to tigecycline were 16-17%. Two isolates of Finegoldia magna were non-susceptible to chloramphenicol (minimum inhibitory concentrations of 16-32 mg/L). Resistance patterns were different among the different hospitals. CONCLUSIONS: Piperacillin-tazobactam, cefoxitin, and carbapemems are highly active beta-lactam agents against most of the anaerobes. The resistance rates to moxifloxacin and tigecycline are slightly higher than those in the previous study.
Agar ; Bacteria, Anaerobic* ; Bacteroides fragilis ; Cefotetan ; Cefoxitin ; Chloramphenicol ; Clindamycin ; Gram-Positive Cocci ; Imipenem ; Korea ; Metronidazole ; Piperacillin

BACKGROUND: The MicroScan MICroSTREP plus panel for susceptibility testing of various streptococci, including Streptococcus pneumoniae, has recently been introduced in Korea. The current study evaluated the usefulness of MicroScan MICroSTREP plus panel for antimicrobial susceptibility test of S. pneumoniae. METHODS: A total of 75 clinical isolates of S. pneumoniae were tested for antimicrobial susceptibility to penicillin, cefotaxime, ceftriaxone, meropenem, vancomycin, clindamycin, erythromycin, and levofloxacin with the MicroScan MICroSTREP plus panel and clinical and laboratory standard institute (CLSI) reference broth microdilution method. For 46 of 75 isolates, additional susceptibility tests to penicillin and cefotaxime were performed with Etest. RESULTS: The overall essential agreement of MICs (within one dilution of MICs) defined by the MicroScan MICroSTREP plus panel and reference method was 93.0%. Overall there were 11.7% minor, 0.7% major, and 0.7% very major interpretative category errors observed. The results of antibiotic susceptibility testing by Etest were similar to those obtained by the MicroScan MICroSTREP plus panel. CONCLUSION: The MicroScan MICroSTREP plus panel, a commercial broth microdilution method, has a comparable accuracy to CLSI broth microdilution method for the resistance testing of S. pneumonia. This panel can be used for determining susceptibilities of S. pneumoniae to a wide variety of antimicrobial agents in clinical microbiology laboratories.
Anti-Infective Agents ; Cefotaxime ; Ceftriaxone ; Clindamycin ; Erythromycin ; Korea ; Ofloxacin ; Penicillins ; Pneumonia ; Streptococcus ; Streptococcus pneumoniae ; Thienamycins ; Vancomycin

BACKGROUND: Increased resistance rates to macrolide-lincosamide-streptogramin B (MLSB) antibiotics among clinical isolates of staphylococci are considered as a consequence of an expanded use of these antibiotics in the treatment of Gram-positive infections. The proportion of MLSB resistance phenotypes of staphylococci is quite different by geographical variations and study periods. The aim of the present study was to determine the distribution of MLSB resistance phenotypes among clinical isolates of staphylococci in a university hospital. METHODS: The MLSB resistance phenotypes of clinical isolates of staphylococci were investigated by the double-disk diffusion test using erythromycin and clindamycin disks. RESULTS: Of 7,916 isolates, 55.7% exhibited a constitutive resistance phenotype (cMLSB) whereas 8.1% expressed an inducible resistance phenotype (iMLSB). Among 3,419 coagulase-negative staphylococci (CNS), 32.6% and 10.0% exhibited cMLSB and iMLSB resistance phenotypes, respectively. Of 4,497 Staphylococcus aureus isolates, 73.1% and 6.8% were cMLSB and iMLSB resistance phenotypes, respectively. cMLSB was detected among 90.2% of methicillin-resistant S. aureus (MRSA), 46.5% of methicillin-resistant CNS (MRCNS), 3.2% of methicillin-susceptible CNS (MSCNS), and 2.2% of methicillin-susceptible S. aureus (MSSA). iMLSB was detected among 16.5% of MSSA, 11.5% of MRCNS, 6.7% of MSCNS, and 4.4% of MRSA. CONCLUSION: MLSB resistance was more prevalent among S. aureus isolates than CNS strains. Although cMLSB was the most frequently detected resistance phenotype among the total staphylococcal isolates, methicillin-susceptible strains exhibited somewhat higher iMLSB resistance rates compared with methicillin-resistant strains.
Anti-Bacterial Agents ; Clindamycin ; Diffusion ; Erythromycin ; Methicillin Resistance ; Phenotype ; Staphylococcus aureus

BACKGROUND: The mechanism of erythromycin resistance of Streptococcus pyogenes results from target modification or active efflux. The purpose of this study was to determine the positive rate of ermAM gene modifying 23S rRNA and that of mefA gene related with efflux for erythromycin-resistant S. pyogenes. METHODS: The minimal inhibitory concentrations (MICs) of erythromycin, azithromycin, clarithromycin, and clindamycin against S. pyogenes were tested by agar dilution method. ermAM and mefA genes were amplified by polymerase chain reaction (PCR) for 32 strains of erythromycin-resistant S. pyogenes. RESULTS: Among the 32 erythromycin-resistant S. pyogenes strains, 20 (62.5%) strains were positive for ermAM gene and 10 (31.1%) for mefA gene. Eighteen (90.0%) out of 20 strains with ermAM gene showed high-level erythromycin resistance (MIC> OR =64 microgram/mL), while all ten strains with mefA gene had low-level erythromycin resistance (MIC< OR =16 microgram/mL). CONCLUSION: Two-thirds of the S. pyogenes strains acquired erythromycin resistance by modification of target site, while the others by active efflux. Each mechanism of resistance is closely associated with range of MICs of erythromycin.
Agar ; Azithromycin ; Clarithromycin ; Clindamycin ; Erythromycin ; Polymerase Chain Reaction ; Streptococcus pyogenes* ; Streptococcus*

Lemierre's syndrome is characterized by a rare fulminant condition resulting from primary oropharyngeal infection followed by secondary septic thrombophlebitis of the internal jugular vein and metastatic infection. A forty-year-old man who had been on ventilator due to severe chest trauma, showed severe reddish inflammatory swelling of the right cervical soft tissue and newly developed pneumonia. He went into in septic condition shortly thereafter. Thrombophlebitis with central abscess in the right internal jugular vein was identified by neck CT and MRA(magnetic resonance angiography). Right cervical swelling worsened in spite of clindamycin and heparin therapy. We performed immediate surgery for removal of septic thrombus and resection of internal jugular vein. Patient's septic condition, pneumonia, and local inflammatory reaction were improved within several days after surgery.
Abscess ; Clindamycin ; Heparin ; Jugular Veins ; Lemierre Syndrome* ; Neck ; Pneumonia ; Thorax ; Thrombophlebitis ; Thrombosis ; Ventilators, Mechanical