{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:49:24Z","timestamp":1790315364259,"version":"4.1.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>Staphylococcus aureus<\/jats:italic> is a major pathogenic bacterium associated with high morbidity and mortality worldwide. It exhibits resistance to multiple antibiotics, complicating treatment options. Despite its clinical significance, there is limited data on the prevalence of <jats:italic>S. aureus<\/jats:italic> infections and the patterns of methicillin and inducible clindamycin resistance, particularly in Ethiopia. Understanding these resistance trends is essential for guiding appropriate therapy and improving patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the prevalence of <jats:italic>S. aureus<\/jats:italic>, methicillin and inducible clindamycin resistance patterns, and associated factors among patients with suspected bacterial infection at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A hospital-based cross-sectional study was conducted among patients suspected of bacterial infections from 10 June 2023 to 28 February 2024. Blood, wound swab, cerebrospinal fluid, urine, eye swab, synovial fluid, ear swab, and pleural fluid were collected aseptically and inoculated onto appropriate media. <jats:italic>S. aureus<\/jats:italic> was identified based on colony morphology, Gram staining, DNase test and biochemical tests. Antimicrobial susceptibility testing was performed on the isolates using the disk diffusion and the D-test techniques based on CLSI guideline. Data were entered into SPSS version 26 for analysis. Logistic regression was applied to assess the relationship between predictors and the outcome variable. A <jats:italic>P<\/jats:italic>-value of \u2264 0.05 with a 95% CI was considered statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 339 study participants, 38 (11.2%) (95% CI: 8\u201315) tested positive for <jats:italic>S. aureus<\/jats:italic>. Of these isolates, 14\/38 (36.9%) were resistant to methicillin, 5\/38 (13.1%) isolates were resistance to clindamycin by routine disk diffusion test whereas 10\/38 (26.3%) isolates exhibited inducible clindamycin resistance using the D-test. The level of multidrug resistance was noted in 10\/38 (26.3%) of the isolates. Significant factors associated with <jats:italic>S. aureus<\/jats:italic> infection included illiteracy (AOR = 13.51; 95% CI: 3.56\u201321.90; <jats:italic>P<\/jats:italic> = 0.018), having larger family size (AOR = 12.14; 95% CI: 2.38\u201320.43; <jats:italic>P<\/jats:italic> = 0.024), and income level of less than 3,000 ETB (AOR = 6.20; 95% CI: 1.03\u201330.09; <jats:italic>P<\/jats:italic> = 0.046).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The study revealed an 11.2% occurrence of <jats:italic>S. aureus<\/jats:italic> among the study participants, with a substantial proportion exhibiting methicillin resistance (36.9%) and inducible clindamycin resistance (26.3%). These findings highlight a higher burden of clindamycin resistance in MRSA, underscoring the need for routine D-test screening to guide appropriate antibiotic therapy. Additionally, factors such illiteracy, low income and residing in rural areas were associated with <jats:italic>S. aureus<\/jats:italic> infection. Targeted health education initiatives should be implemented, especially in rural areas and among populations with low literacy levels, to improve hygiene practices and reduce transmission.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmicb.2025.1569242","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T05:49:56Z","timestamp":1749793796000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Methicillin and inducible clindamycin resistance in clinical Staphylococcus aureus isolates: a cross-sectional study from Northwest Ethiopia"],"prefix":"10.3389","volume":"16","author":[{"given":"Zemen","family":"Addis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yibeltal","family":"Aschale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abebe","family":"Fenta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zigale Hibstu","family":"Teffera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abateneh","family":"Melkamu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abeba","family":"Tigab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tebelay","family":"Dilnessa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"6155","DOI":"10.2147\/IDR.S429687","article-title":"Antimicrobial resistance patterns of Staphylococcus aureus and enterococcus species at the ethiopian public health institute, Ethiopia: A five-year retrospective analysis.","volume":"16","author":"Abdeta","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"B2","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1186\/s12879-017-2584-5","article-title":"Inducible clindamycin and methicillin resistant Staphylococcus aureus in a tertiary care hospital, Kathmandu, Nepal.","volume":"17","author":"Adhikari","year":"2017","journal-title":"BMC Infect. Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2434350","DOI":"10.1155\/2020\/2434350","article-title":"Prevalence and molecular genetics of methicillin-resistant Staphylococcus aureus colonization in nursing homes in Saudi Arabia.","volume":"2020","author":"Albarrag","year":"2020","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"B4","first-page":"9","article-title":"Distribution of mecA gene amongst Staphylococcus aureus isolates from Southwestern Nigeria.","volume":"14","author":"Alli","year":"2011","journal-title":"Afr. J. Biomed. Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"6503929","DOI":"10.1155\/2022\/6503929","article-title":"Prevalence and clindamycin resistance profile of staphylococcus aureus and associated factors among patients attending the university of gondar comprehensive specialized hospital, gondar, Northwest Ethiopia.","volume":"2022","author":"Ambachew","year":"2022","journal-title":"Interdiscip. Perspect. Infect. Dis."},{"key":"B6","doi-asserted-by":"publisher","first-page":"6615727","DOI":"10.1155\/2021\/6615727","article-title":"Practice on Metered Dose inhaler techniques and its associated factors among asthmatic patients at debre markos comprehensive specialized hospital, East Gojjam, Ethiopia: A Prospective study.","volume":"2021","author":"Asmare","year":"2021","journal-title":"ScientificWorldJournal"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1835603","DOI":"10.1155\/2022\/1835603","article-title":"Inducible clindamycin-resistant Staphylococcus aureus strains in africa: A systematic review.","volume":"2022","author":"Assefa","year":"2022","journal-title":"Int. J. Microbiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"49","DOI":"10.4103\/0377-4929.44963","article-title":"Inducible clindamycin resistance among clinical isolates of Staphylococci.","volume":"52","author":"Ciraj","year":"2009","journal-title":"Indian J. Pathol. Microbiol."},{"key":"B9","year":"2022","journal-title":"Performance Standards for Antimicrobial Susceptibility Testing. CLSI supplement M100"},{"key":"B10","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.jare.2019.10.005","article-title":"Vancomycin resistant Staphylococcus aureus infections: A review of case updating and clinical features.","volume":"21","author":"Cong","year":"2020","journal-title":"J. Adv. Res."},{"key":"B11","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1128\/CMR.00081-09","article-title":"Community-associated methicillin-resistant Staphylococcus aureus: Epidemiology and clinical consequences of an emerging epidemic.","volume":"23","author":"David","year":"2010","journal-title":"Clin. Microbiol. Rev."},{"key":"B12","doi-asserted-by":"publisher","first-page":"124","DOI":"10.4103\/0255-0857.62488","article-title":"Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples.","volume":"28","author":"Deotale","year":"2010","journal-title":"Indian J. Med. Microbiol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1016\/j.meegid.2008.07.007","article-title":"The evolution of Staphylococcus aureus.","volume":"8","author":"Deurenberg","year":"2008","journal-title":"Infect. Genet. Evol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"S47","DOI":"10.1093\/ofid\/ofy270","article-title":"Twenty-year trends in antimicrobial susceptibilities among Staphylococcus aureus from the SENTRY antimicrobial surveillance program.","volume":"6","author":"Diekema","year":"2019","journal-title":"Open Forum. Infect. Dis."},{"key":"B15","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1186\/s12879-016-1742-5","article-title":"Prevalence and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus isolated from clinical samples at Yekatit 12 hospital medical college, Addis Ababa, Ethiopia.","volume":"16","author":"Dilnessa","year":"2016","journal-title":"BMC Infect. Dis."},{"key":"B16","doi-asserted-by":"publisher","first-page":"4740","DOI":"10.1128\/JCM.41.10.4740-4744.2003","article-title":"Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci.","volume":"41","author":"Fiebelkorn","year":"2003","journal-title":"J. Clin. Microbiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"8321834","DOI":"10.1155\/2019\/8321834","article-title":"Methicillin-resistant Staphylococcus aureus (MRSA): Prevalence and antimicrobial sensitivity pattern among patients-a multicenter study in Asmara, Eritrea.","volume":"2019","author":"Garoy","year":"2019","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1093\/jac\/dkl017","article-title":"Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK.","volume":"57","author":"Gemmell","year":"2006","journal-title":"J. Antimicrob. Chemother."},{"key":"B19","doi-asserted-by":"publisher","first-page":"107","DOI":"10.3389\/fcimb.2020.00107","article-title":"Prevalence and therapies of antibiotic-resistance in Staphylococcus aureus.","volume":"10","author":"Guo","year":"2020","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1086\/587658","article-title":"The interaction between nutrition and infection.","volume":"46","author":"Katona","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/1476-0711-12-11","article-title":"Prevalence and antibiotic susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) among primary school children and prisoners in Jimma Town, Southwest Ethiopia.","volume":"12","author":"Kejela","year":"2013","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"B22","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1186\/s13104-018-3817-4","article-title":"Phenotypic and genotypic characterization of macrolide, lincosamide and streptogramin B resistance among clinical isolates of staphylococci in southwest of Iran.","volume":"11","author":"Khashei","year":"2018","journal-title":"BMC Res. Notes"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.3855\/jidc.12250","article-title":"Inducible clindamycin resistance in clinical isolates of staphylococcus aureus in Suez Canal University Hospital, Ismailia, Egypt.","volume":"14","author":"Kishk","year":"2020","journal-title":"J. Infect. Dev. Ctries"},{"key":"B24","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.mjafi.2013.01.004","article-title":"Prevalence of inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples.","volume":"70","author":"Lall","year":"2014","journal-title":"Med. J. Armed. Forces India"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1016\/S1473-3099(13)70318-9","article-title":"Antibiotic resistance- the need for global solutions.","volume":"13","author":"Laxminarayan","year":"2013","journal-title":"Lancet Infect. Dis."},{"key":"B26","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1086\/324626","article-title":"Mechanisms of resistance to macrolides and lincosamides: Nature of the resistance elements and their clinical implications.","volume":"34","author":"Leclercq","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"B27","doi-asserted-by":"publisher","first-page":"18033","DOI":"10.1038\/nrdp.2018.33","article-title":"Methicillin-resistant Staphylococcus aureus.","volume":"4","author":"Lee","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1056\/NEJMoa1306801","article-title":"Multistate point-prevalence survey of health care-associated infections.","volume":"370","author":"Magill","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance.","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/2965490","article-title":"Methicillin- and inducible clindamycin-resistant staphylococcus aureus among patients with wound infection attending arba minch hospital, South Ethiopia.","volume":"2019","author":"Mama","year":"2019","journal-title":"Int. J. Microbiol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1086\/526773","article-title":"Clinical practice: Colonization, fomites, and virulence: Rethinking the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection.","volume":"46","author":"Miller","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"B32","doi-asserted-by":"publisher","first-page":"3848073","DOI":"10.1155\/2023\/3848073","article-title":"Prevalence of methicillin-resistant Staphylococcus aureus and multidrug-resistant strains from patients attending the referral hospitals of amhara regional state, Ethiopia.","volume":"2023","author":"Moges","year":"2023","journal-title":"Int. J. Microbiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e01391-19","DOI":"10.1128\/JCM.01391-19","article-title":"Tailoring antimicrobial susceptibility testing to individual species of coagulase-negative staphylococci: Next up, Staphylococcus epidermidis.","volume":"57","author":"Morris","year":"2019","journal-title":"J. Clin. Microbiol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1196\/annals.1425.011","article-title":"Poverty and access to health care in developing countries.","volume":"1136","author":"Peters","year":"2008","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"B35","first-page":"82","article-title":"Inducible clindamycin resistance in Staphylococcus aureus isolates recovered from Mashhad.","volume":"4","author":"Seifi","year":"2012","journal-title":"Iran. Iran J. Microbiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/1471-2334-6-125","article-title":"Antimicrobial susceptibility patterns and characterization of clinical isolates of Staphylococcus aureus in KwaZulu-Natal province, South Africa.","volume":"6","author":"Shittu","year":"2006","journal-title":"BMC Infect. Dis."},{"key":"B37","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1186\/s12879-017-2384-y","article-title":"Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection and the molecular characteristics of MRSA bacteraemia over a two-year period in a tertiary teaching hospital in Malaysia.","volume":"17","author":"Sit","year":"2017","journal-title":"BMC Infect Dis."},{"key":"B38","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1093\/jac\/dkm416","article-title":"Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis.","volume":"61","author":"Tacconelli","year":"2008","journal-title":"J. Antimicrob. Chemother."},{"key":"B39","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1186\/s12879-017-2713-1","article-title":"Antimicrobial resistance in Africa: A systematic review.","volume":"17","author":"Tadesse","year":"2017","journal-title":"BMC Infect. Dis."},{"key":"B40","doi-asserted-by":"publisher","first-page":"3053","DOI":"10.2147\/IDR.S324042","article-title":"Methicillin and vancomycin resistant Staphylococcus aureus and associated factors from surgical ward inpatients at debre markos referral hospital, Northwest Ethiopia.","volume":"14","author":"Tefera","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s41182-021-00392-2","article-title":"Staphylococcus aureus with inducible clindamycin resistance and methicillin resistance in a tertiary hospital in Nepal.","volume":"49","author":"Thapa","year":"2021","journal-title":"Trop. Med. Health"},{"key":"B42","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1128\/CMR.00134-14","article-title":"Staphylococcus aureus infections: Epidemiology, pathophysiology, clinical manifestations, and management.","volume":"28","author":"Tong","year":"2015","journal-title":"Clin. Microbiol. Rev."},{"key":"B43","doi-asserted-by":"publisher","first-page":"3168325","DOI":"10.1155\/2020\/3168325","article-title":"Prevalence of methicillin-resistant Staphylococcus aureus and associated risk factors among patients with wound infection at referral hospital, Northeast Ethiopia.","volume":"2020","author":"Tsige","year":"2020","journal-title":"J. Pathog."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40064-016-2277-3","article-title":"High frequency of methicillin-resistant Staphylococcus aureus in peshawar region of Pakistan.","volume":"5","author":"Ullah","year":"2016","journal-title":"Springerplus"},{"key":"B45","first-page":"131","article-title":"Macrolides, lincosamides, streptogramines (MLS): Mechanisms of action and resistance.","volume":"55","author":"Ungureanu","year":"2010","journal-title":"Bacteriol. Virusol. Parazitol. Epidemiol."},{"key":"B46","doi-asserted-by":"crossref","DOI":"10.1128\/9781555816728","author":"Versalovic","year":"2011","journal-title":"Manual of Clinical Microbiology: American Society for Microbiology."},{"key":"B47","doi-asserted-by":"publisher","first-page":"2332","DOI":"10.4172\/2332-0877.1000189","article-title":"Antimicrobial susceptibility patterns of Methicillin-resistant Staphylococcus aureus isolates collected from healthcare and community facilities in Libya show a high level of resistance to fusidic acid.","volume":"2","author":"Wareg","year":"2014","journal-title":"J. Infect. Dis. Ther."},{"key":"B48","year":"2014","journal-title":"Antimicrobial Resistance: Global Report on Surveillance."},{"key":"B49","year":"2015","journal-title":"Global Action Plan on Antimicrobial Resistance."},{"key":"B50","year":"2017","journal-title":"Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development of New Antibiotics."},{"key":"B51","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1177\/1010539517717365","article-title":"Disease Burden, Characteristics, and Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection in Hong Kong.","volume":"29","author":"You","year":"2017","journal-title":"Asia Pac. J. Public Health"}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2025.1569242\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T05:49:59Z","timestamp":1749793799000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2025.1569242\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,13]]},"references-count":51,"alternative-id":["10.3389\/fmicb.2025.1569242"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2025.1569242","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,13]]},"article-number":"1569242"}}