title: Antimicrobial resistance in Haemophilus influenzae respiratory tract isolates in Korea: results of a nationwide acute respiratory infections surveillance.
abstract: Antimicrobial susceptibility patterns and beta-lactam resistance mechanisms of 544 Haemophilus influenzae isolates through the nationwide Acute Respiratory Infections Surveillance (ARIS) network in Korea during 2005 and 2006 were determined. Resistance to ampicillin was 58.5%, followed by resistance to cefuroxime (23.3%), clarithromycin (18.7%), cefaclor (17.0%), amoxicillin-clavulanate (10.4%), and chloramphenicol (8.1%). Levofloxacin and cefotaxime were the most active agents tested in this study. beta-Lactamase production (52.4%) was the main mechanism of ampicillin resistance, affecting 96.1% of TEM-1-type beta-lactamase. According to their beta-lactam resistance mechanisms, all isolates were classified into the following groups: beta-lactamase-negative, ampicillin-sensitive (BLNAS) strains (n = 224; 41.5%); beta-lactamase-positive, ampicillin-resistant (BLPAR) strains (n = 255; 47.2%); beta-lactamase-negative, ampicillin-resistant (BLNAR) strains (n = 33; 6.1%); and beta-lactamase-positive, amoxicillin-clavulanate-resistant (BLPACR) strains (n = 28; 5.2%). Among the BLNAR and BLPACR strains, there were various patterns of multiple-amino-acid substitutions in penicillin-binding protein 3. Particularly, among BLNAR, group III isolates, which had three simultaneous substitutions (Met377Ile, Ser385Thr, and Leu389Phe), were identified for the first time in Korea. Three group III strains displayed the highest MIC of cefotaxime (1 to 2 mug/ml). The results indicate the importance of monitoring a changing situation pertaining to the increase and spread of BLNAR and BLPACR strains of H. influenzae for appropriate antibiotic therapy for patients with respiratory tract infections in Korea.
authors.affiliation: Division of Bacterial Respiratory Infections, Center for Infectious Diseases, National Institute of Health, Korea Centers for Disease Control and Prevention, 5 Nokbun-Dong, Eunpyung-Ku, Seoul 122-701, South Korea. songmee@hanmail.net
authors.forename: Songmee
authors.initials: S
authors.lastname: Bae
authors.forename: Jaehoon
authors.initials: J
authors.lastname: Lee
authors.forename: Jaehwa
authors.initials: J
authors.lastname: Lee
authors.forename: Eunah
authors.initials: E
authors.lastname: Kim
authors.forename: Sunhwa
authors.initials: S
authors.lastname: Lee
authors.forename: Jaeyon
authors.initials: J
authors.lastname: Yu
authors.forename: Yeonho
authors.initials: Y
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000595:Amino Acid Sequence; D019943:Amino Acid Substitution; D000667:Ampicillin / Q000494:pharmacology; D000668:Ampicillin Resistance; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000235:genetics; D024881:Drug Resistance, Bacterial; D005260:Female; D006192:Haemophilus Infections / Q000453:epidemiology* / Q000382:microbiology*; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D007223:Infant; D007723:Korea / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008969:Molecular Sequence Data; D046915:Penicillin-Binding Proteins / Q000235:genetics; D011159:Population Surveillance; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000382:microbiology*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012703:Serotyping; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism
chemical_list: D004269:DNA, Bacterial; D046915:Penicillin-Binding Proteins; D000667:Ampicillin; D001618:beta-Lactamases