title: Non-typeable Haemophilus influenzae biofilm production and severity in lower respiratory tract infections in a tertiary hospital in Mexico.
abstract: Non-typeable Haemophilus influenzae (NTHi) is a common opportunistic bacterial pathogen that primarily infects the respiratory mucosa. This study was conducted to assess clinical and microbiological data related to disease severity in patients with lower respiratory tract infections caused by NTHi in a tertiary care hospital in Mexico. NTHi isolates were subjected to serotyping, antimicrobial susceptibility evaluationand analyses of β-lactamase production, genetic relatednessand biofilm formation. Clinical and demographic data were retrieved from patients' records. The mean age of the patients was 40.3 years; the majority (n=44, 72.1 %) were male. The main comorbidities were arterial hypertension (n=22, 36.1 %) and diabetes mellitus (n=17, 27.9 %). NTHi isolates (n=98) were recovered from tracheal aspirate (n=57, 58.2 %), sputum (n=26, 26.5 %)and bronchial aspirate (n=15, 15.3 %) specimens. Low resistance to cefotaxime (n=0, 0.0 %), rifampin (n=1, 1.1 %) and chloramphenicol (n=3, 3.2 %) and greater resistance to ampicillin (n=30, 32.3 %) and trimethoprim-sulfamethoxazole (n=49, 52.7 %) were detected. β-Lactamase production was found in 17 (17.3 %) isolates. Isolates displayed high genetic diversity, and only 10 (10.2 %) were found to be biofilm producers. The antimicrobial susceptibility patterns of biofilm-producing and non-producing isolates did not differ. Biofilm production was associated with prolonged hospital stay (P=0.05). Lower respiratory NTHi isolates from Mexico showed low antimicrobial resistance and weak biofilm production. Younger age was correlated with lower Acute Physiology and Chronic Health Evaluation II score (moderate, P=0.07; severe, P=0.03).
authors.affiliation: Servicio de Infectología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Michel Fernando
authors.initials: MF
authors.lastname: Martínez-Reséndez
authors.affiliation: Departamento de Medicina Interna, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: González-Chávez
authors.affiliation: Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico.|Departamento de Patología Clínica, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Elvira
authors.initials: E
authors.lastname: Garza-González
authors.affiliation: Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Lorena Nefertiti
authors.initials: LN
authors.lastname: Castro-Fuentes
authors.affiliation: Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Jessica Lizzeth
authors.initials: JL
authors.lastname: Gutiérrez-Ferman
authors.affiliation: Departamento de Evaluación de Vacunas, Instituto Nacional de Salud Pública. Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100. Cuernavaca, Morelos, Mexico.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Echániz-Aviles
authors.affiliation: Servicio de Infectología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Adrián
authors.initials: A
authors.lastname: Camacho-Ortíz
authors.affiliation: Departamento de Evaluación de Vacunas, Instituto Nacional de Salud Pública. Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100. Cuernavaca, Morelos, Mexico.
authors.forename: María Noemí
authors.initials: MN
authors.lastname: Carnalla-Barajas
authors.affiliation: Departamento de Evaluación de Vacunas, Instituto Nacional de Salud Pública. Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100. Cuernavaca, Morelos, Mexico.
authors.forename: Araceli
authors.initials: A
authors.lastname: Soto-Noguerón
authors.affiliation: Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Héctor Jesús
authors.initials: HJ
authors.lastname: Maldonado-Garza
authors.affiliation: Servicio de Infectología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Cristina Liliana
authors.initials: CL
authors.lastname: Hernández-Balboa
authors.affiliation: Departamento de Patología Clínica, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Jorge M
authors.initials: JM
authors.lastname: Llaca-Díaz
authors.affiliation: Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Samantha
authors.initials: S
authors.lastname: Flores-Treviño
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D018441:Biofilms / Q000254:growth & development*; D001980:Bronchi / Q000382:microbiology; D015897:Comorbidity; D005260:Female; D014644:Genetic Variation; D006192:Haemophilus Infections / Q000453:epidemiology / Q000382:microbiology*; D006193:Haemophilus influenzae / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000502:physiology*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D012703:Serotyping; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology; D062606:Tertiary Care Centers; D014132:Trachea / Q000382:microbiology; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases