Phenotypic-Genotypic Characterization of Macrolide-Lincosamide-Streptogramin B Resistance in Staphylococcus saprophyticus UTI Isolates from Iraq
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Abstract
Staphylococcus saprophyticus is a significant uropathogen, particularly in young women. Rising macrolide-lincosamide-streptogramin B (MLSB) resistance poses therapeutic challenges. This study characterized phenotypic and genotypic MLSB resistance patterns among S. saprophyticus UTI isolates in Najaf, Iraq. Forty-two S. saprophyticus isolates were collected from urine samples (February-April 2025) from patients aged 1-70 years. Phenotypic resistance was assessed using the D-test methodology following CLSI guidelines. PCR amplification targeted eight resistance genes: erm(C) and msr(A). Isolates predominantly originated from females (28/42, 66.7%), with the highest frequency in age groups 21-30 (11/42, 26.2%) and 31-40 years (10/42, 23.8%). The D-test revealed that 25/42 (59.5%) isolates exhibited MLSB resistance: 9/42 (21.4%) demonstrated an inducible MLSB (iMLSB) phenotype, 16/42 (38.1%) exhibited a constitutive MLSB (cMLSB) phenotype, and 8/42 (19.0%) displayed a macrolide-streptogramin B (MS) phenotype, while 9/42 (21.4%) were MLSB-negative. Molecular analysis detected resistance genes in only 9 of 25 (36%) phenotypically MLSB-positive isolates. The erm(C) gene alone was present in 2/25 (8%) isolates, while erm(C)+msr(A) combination dominated at 7/25 (28%). High MLSB resistance prevalence (59.5%) among S. saprophyticus isolates, with cMLSB predominance and significant genotype-phenotype discordance (64% phenotypically positive lacking detected genes), emphasizes the necessity for routine D-testing and expanded molecular surveillance to guide antimicrobial therapy in Iraqi healthcare settings.
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References
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