Clindamycin resistance among Staphylococcus aureus strains in Israel: implications for empirical treatment of skin and soft tissue infections

• Clindamycin resistance among methicillin-susceptible Staphylococcus aureus infection strains has increased dramatically in Israel.
• The prevalence of community-acquired methicillin-resistant S. aureus (MRSA) has been relatively low among children in Israel.
• MRSA rates are higher in adults, especially in residents of long-term care facilities.
• Empirical treatment for skin and soft tissue infections should reflect these findings.

SummaryObjectivesThe objectives of this study were to characterize isolates of Staphylococcus aureus obtained from skin and soft tissue infections in the community in Israel and to document the sensitivity patterns for commonly used antimicrobial agents.MethodsThe susceptibilities of S. aureus isolates from skin and soft tissue infections in the community in Israel were reviewed to determine the appropriate empirical therapy for these infections.ResultsA total of 7221 isolates were collected during the period 2009–2012; 39% were from children (age 0–18 years). In children, S. aureus oxacillin resistance dropped from 8.4% to 3.8% (p = 0.073). While inducible clindamycin resistance increased slightly from 20% to 25%, there was a prominent increase in constitutive clindamycin resistance from 0.1% to 26.8% (p = 0.012). In adults, oxacillin resistance increased from 16% to 23% (p < 0.001) and constitutive clindamycin resistance increased notably from 5% to 29% (p < 0.001). These findings demonstrate a dramatic increase in clindamycin resistance among S. aureus isolates and suggest against the usage of clindamycin as empirical treatment for suspected S. aureus infections in Israel.ConclusionsBeta-lactam anti-staphylococcal agents may be given as empirical treatment for children, but should be considered according to risk factors for adults in Israel.