title: Differentiation of beta-lactamase-negative ampicillin-resistant Haemophilus influenzae from other H. influenzae strains by a disc method.
abstract: We established breakpoints for differentiating ampicillin (ABPC)-susceptible strains from resistant strains among Haemophilus influenzae isolates according to susceptibility to various beta-lactam antibiotics, using a disc method. Susceptibility testing of isolates for 13 beta-lactam agents was followed by analysis of the resistance genes, using a polymerase chain reaction (PCR) to identify the TEM-1 beta-lactamase gene ( bla) and the ftsI gene encoding penicillin-binding protein (PBP) 3, which affects beta-lactam minimum inhibitory concentrations (MICs). A total of 228 H. influenzae isolates were classified into 114 beta-lactamase-negative, ABPC-susceptible (BLNAS) strains; 29 beta-lactamase-negative, ABPC-resistant (BLNAR) strains; 53 low-BLNAR strains with a low degree of ABPC resistance; 27 TEM-1-producing strains (BLPAR); and 5 strains with ftsI gene mutations in addition to TEM-1 production (BLPACR) according to the PCR results. To identify resistant strains by disc-method susceptibility testing, the zone of inhibition was measured for ABPC (10 microg/disc), cefaclor (30 microg/disc), cefpodoxime (10 microg/disc), and cefdinir (5 microg/disc) discs. Strains were identified as BLNAS without resistant genes when the diameter was > or =27 mm for the ABPC disc and > or =21 mm for the cefaclor disc. Other strains were identified as BLNAR when the diameter was < or =22 mm for the cefpodoxime disc and < or =17 mm for the cefdinir disc. Remaining strains were identified as low-BLNAR. These criteria differentiated resistance types with high accuracy. A discrepancy was noted between genetic results and disc-testing breakpoints for differentiating resistant from susceptible H. influenzae. A disc-testing breakpoint for cefditoren (5 microg/disc) was proposed, with the susceptibility statistically defined as a diameter of > or =24 mm, which corresponds to the breakpoint (1 microg/ml) of the microdilution method recommended by the Japanese Society of Chemotherapy.
authors.affiliation: Center for Epideniology and Clinical Microbiology, Pharmaceutical Research Center, Meiji Seika Kaisha, Ltd., 760 Morookacho, Kohoku-ku, Yokohama 222-8567, Japan. kimiko_ubukata@meiji.co.jp
authors.forename: Kimiko
authors.initials: K
authors.lastname: Ubukata
authors.forename: Naoko
authors.initials: N
authors.lastname: Chiba
authors.forename: Keiko
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Yumi
authors.initials: Y
authors.lastname: Shibasaki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Sunakawa
authors.forename: Masato
authors.initials: M
authors.lastname: Nonoyama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iwata
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Konno
mesh_terms: D000668:Ampicillin Resistance; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000201:enzymology; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods*; D001618:beta-Lactamases / Q000378:metabolism*; D047090:beta-Lactams
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D001618:beta-Lactamases