Susceptibility of methicillin-resistant Staphylococcus aureus clinical isolates to various antimicrobial agents. III. Novel, inducible resistance to macrolide-lincosamide-streptogramin B (MLS) antibiotics.

Resistance patterns against 25 antimicrobial agents consisting of beta-lactams, aminoglycosides, tetracyclines, fluoroquinolones, macrolides and etc. were examined for 69 strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated at Hiroshima University Hospital from July 1991 to April 1992. Regarding overall resistance (the percentage of highly and moderately resistant strains), the following antimicrobial agents were no more effective chemotherapeutics for MRSA infections (%resistance): methicillin (100), flomoxef (100), kanamycin (100), tobramycin (100), amikacin (100), isepamicin (100), gentamicin (78), dibekacin (100), ofloxacin (99), levofloxacin (99), temafloxacin (99), erythromycin (100), clarithromycin (100), tetracycline (93), minocycline (93) and fosfomycin (100). Further spread of arbekacin-resistant strain, which was isolated in April 1991, into a clinical environment could not be recognized during the period covered in the present study. All the MRSA strains were resistant either constitutively (26 strains) or inducibly (43 strains) to macrolide-lincosamide-streptogramin B (MLS) antibiotics. When expression is constitutive, the strains are resistant to all MLS antibiotics. In contrast, 16-membered macrolide (i.e., jasamycin), lincomycin and mikamycin B escape resistance in the strains with a typical inducible resistance overcome in the presence of 14-membered macrolides by a translational attenuation mechanism. Three of 4 beta-lactamase-positive strains, however, can not be classified in these two resistance groups, being exclusively resistant to mikamycin B. The strains grown in the presence of any inducing MLS antibiotic became susceptible to mikamycin B even in the inducer-free culture.