<sec>
<b>Objectives</b>
<p>Genetic determinants conferring resistance to macrolide, lincosamide, and streptogramin B (MLS<sub>B</sub>) via ribosomal modification such as, <italic>erm</italic>, <italic>msrA/B</italic> and <italic>ereA/B</italic> genes are distributed in bacteria. The main goals of this work were to evaluate the dissemination of MLS<sub>B</sub> resistance phenotypes and genotypes in methicillin-resistant <italic>Staphylococcus aureus</italic> (MRSA) isolates collected from clinical samples.</p></sec>
<sec>
<b>Methods</b>
<p>A total of 106 MRSA isolates were studied. Isolates were recovered from 3 hospitals in Tehran between May 2016 to July 2017. The prevalence of MLS<sub>B</sub>-resistant strains were determined by D-test, and then M-PCR was performed to identify genes encoding resistance to macrolides, lincosamides, and streptogramins in the tested isolates.</p></sec>
<sec>
<b>Results</b>
<p>The frequency of constitutive resistance MLS<sub>B</sub>, inducible resistance MLS<sub>B</sub> and MS<sub>B</sub> resistance were 56.2%, 22.9%, and 16.6%, respectively. Of 11 isolates with the inducible resistance MLS<sub>B</sub> phenotype, <italic>ermC</italic>, <italic>ermB</italic>, <italic>ermA</italic> and <italic>ereA</italic> were positive in 81.8%, 63.6%, 54.5% and 18.2% of these isolates, respectively. In isolates with the constitutive resistance MLS<sub>B</sub> phenotype, the prevalence of <italic>ermA</italic>, <italic>ermB</italic>, <italic>ermC</italic>, <italic>msrA</italic>, <italic>msrB</italic>, <italic>ereA</italic> and <italic>ereB</italic> were 25.9%, 18.5%, 44.4%, 0.0%, 0.0%, 11.1% and 0.0%, respectively.</p></sec>
<sec>
<b>Conclusion</b>
<p>Clindamycin is commonly administered in severe MRSA infections depending upon the antimicrobial susceptibility findings. This study showed that the D-test should be used as an obligatory method in routine disk diffusion assay to detect inducible clindamycin resistance in MRSA so that effective antibiotic treatment can be provided.</p></sec>
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