title: Clonal spread of beta-lactamase-producing amoxicillin-clavulanate-resistant (BLPACR) strains of non-typeable Haemophilus influenzae among young children attending a day care in Japan.
abstract: OBJECTIVE
  Resistant strains of non-typeable Haemophilus influenzae (NTHi) are one of the principal causes of recurrent acute otitis media (otitis prone), rhinosinusitis, and pneumonia in young children. Beta-lactamase-nonproducing ampicillin-resistant (BLNAR) strains are particularly common in Japan, and beta-lactamase-producing amoxicillin-clavulanate resistant (BLPACR) strains are now emerging. We investigated the nasopharyngeal carriage status of these resistant strains among children attending a same day care center during a 10-year period.
  
  
  METHODS
  From 1999 to 2008, we obtained nasopharyngeal swab specimens from young children attending a same day care center and examined the incidence of resistant strains of NTHi. Antimicrobial resistance of NTHi was identified based on PCR analysis of mutation of the penicillin binding protein (PBP) genes. Pulsed-field gel electrophoresis (PFGE) was performed to examine the clonal relationship of each resistant strain.
  
  
  RESULTS
  The prevalence of resistant strains of NTHi among the children attending this day care has significantly increased during the past 10 years and most of this day care children recently have resistant strains with PBP gene mutations in their nasopharynx. Genetically BLPACR (gBLPACR) strains have rapidly increased since 2007 and PFGE analysis demonstrated that all gBLPACR were clonally identical. This is the first report of apparent clonal dissemination of gBLPACR strains of NTHi occurring in a certain environment such as day care.
  
  
  CONCLUSIONS
  The rapidly increasing prevalence of resistant strains, in particular gBLPACR, in this day care center may predict a high incidence of these resistant bacteria from clinical isolates in the near future and potential serious medical problems worldwide.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8640, Japan. makoto@med.kanazawa-u.ac.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Ito
authors.forename: Muneki
authors.initials: M
authors.lastname: Hotomi
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Maruyama
authors.forename: Miyako
authors.initials: M
authors.lastname: Hatano
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Yoshizaki
authors.forename: Noboru
authors.initials: N
authors.lastname: Yamanaka
mesh_terms: D019980:Amoxicillin-Potassium Clavulanate Combination / Q000494:pharmacology*; D002353:Carrier State; D002656:Child Day Care Centers; D002675:Child, Preschool; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005260:Female; D006192:Haemophilus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D015994:Incidence; D007223:Infant; D007564:Japan / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D019980:Amoxicillin-Potassium Clavulanate Combination; D001618:beta-Lactamases