title: Haemophilus influenzae Isolated From Men With Acute Urethritis: Its Pathogenic Roles, Responses to Antimicrobial Chemotherapies, and Antimicrobial Susceptibilities.
abstract: There have been few comprehensive studies on Haemophilus influenza-positive urethritis.
  
  
  
  In this retrospective study, we enrolled 68 men with H. influenzae-positive urethritis, including coinfections with Neisseria gonorrhoeae, Chlamydia trachomatis, and/or genital mycoplasmas: 2, 3, 20, and 43 treated with ceftriaxone, levofloxacin, sitafloxacin, and extended-release azithromycin (azithromycin-SR), respectively. We assessed microbiological outcomes in 54 men and clinical outcomes in 46 with H. influenzae-positive monomicrobial nongonococcal urethritis. We determined minimum inhibitory concentrations (MICs) of 6 antimicrobial agents for 59 pretreatment isolates.
  
  
  
  H. influenzae was eradicated from the men treated with ceftriaxone, levofloxacin, or sitafloxacin. The eradication rate with azithromycin-SR was 85.3%. The disappearance or alleviation of urethritis symptoms and the decreases in leukocyte counts in first-voided urine were significantly associated with the eradication of H. influenzae after treatment. For the isolates, ceftriaxone, levofloxacin, sitafloxacin, azithromycin, tetracycline, and doxycycline MICs were ≤0.008-0.25, 0.008-0.5, 0.001-0.008, 0.12-1, 0.25-16, and 0.25-2 μg/mL, respectively. The azithromycin MICs for 3 of 4 strains persisting after azithromycin-SR administration were 1 μg/mL. H. influenzae with an azithromycin MIC of 1 μg/mL increased chronologically.
  
  
  
  H. influenzae showed good responses to the chemotherapies for urethritis. The significant associations of the clinical outcomes of the chemotherapies with their microbiological outcomes suggested that H. influenzae could play pathogenic roles in urethritis. All isolates, except for one with decreased susceptibility to tetracyclines, were susceptible to the examined agents. However, the increase in H. influenzae with an azithromycin MIC of 1 μg/mL might threaten efficacies of azithromycin regimens on H. influenzae-positive urethritis.
authors.affiliation: From the *iClinic, 5-9-6 Nagamachi, Taihaku-ku, Sendai, Miyagi; †Department of Urology, Graduate School of Medicine, Gifu University, Gifu City, Gifu; and ‡Department of Bacteriology I, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Ito
authors.forename: Kyoko
authors.initials: K
authors.lastname: Hatazaki
authors.forename: Ken
authors.initials: K
authors.lastname: Shimuta
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kondo
authors.forename: Kosuke
authors.initials: K
authors.lastname: Mizutani
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Yasuda
authors.forename: Keita
authors.initials: K
authors.lastname: Nakane
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Yokoi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakano
authors.forename: Makoto
authors.initials: M
authors.lastname: Ohinishi
authors.forename: Takashi
authors.initials: T
authors.lastname: Deguchi
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D017963:Azithromycin / Q000494:pharmacology; D002443:Ceftriaxone / Q000494:pharmacology; D002690:Chlamydia Infections / Q000188:drug therapy / Q000382:microbiology; D002692:Chlamydia trachomatis; D060085:Coinfection / Q000188:drug therapy; D004318:Doxycycline / Q000494:pharmacology; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D024841:Fluoroquinolones / Q000494:pharmacology; D006069:Gonorrhea / Q000188:drug therapy / Q000382:microbiology; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007958:Leukocyte Count / Q000379:methods; D064704:Levofloxacin / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae; D012189:Retrospective Studies; D014526:Urethritis / Q000188:drug therapy* / Q000382:microbiology* / Q000652:urine
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D064704:Levofloxacin; D002443:Ceftriaxone; D017963:Azithromycin; C076246:sitafloxacin; D004318:Doxycycline