A nosocomial outbreak of amoxycillin-resistant non-typable Haemophilus infiuenzae in a respiratory ward

Hekker, T. A. M.; Schee, Alexandr; Kempers, J.; Namavar, F.; Alphen, Loek van

doi:10.1016/0195-6701(91)90125-r

Cited by 9 publications

(3 citation statements)

References 19 publications

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“…Two of the CG5 isolates were sampled from persons within the same household. Person-to-person transmission of nontypeable H. influenzae has been reported previously, including an outbreak with an amoxicillin-resistant strain in a respiratory ward [27] and intrafamilial transmission of rPBP3 strains [28]. These observations highlight the importance of hygiene measures in health institutions to prevent nosocomial spread.…”

Section: Figurementioning

confidence: 56%

Emergence of clonally related multidrug resistant Haemophilus influenzae with penicillin-binding protein 3-mediated resistance to extended-spectrum cephalosporins, Norway, 2006 to 2013

et al. 2014

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Resistance to cephalosporins in Haemophilus influenzae is usually caused by characteristic alterations in penicillin-binding protein 3 (PBP3), encoded by the ftsI gene. Resistance to extended-spectrum cephalosporins is associated with high-level PBP3-mediated resistance (high-rPBP3), defined by the second stage S385T substitution in addition to a first stage substitution (R517H or N526K). The third stage L389F substitution is present in some high-rPBP3 strains. High-rPBP3 H. influenzae are considered rare outside Japan and Korea. In this study, 30 high-rPBP3 isolates from Norway, collected between 2006 and 2013, were examined by serotyping, multilocus sequence typing (MLST), ftsI sequencing, detection of betalactamase genes and minimum inhibitory concentration (MIC) determination. MICs were interpreted according to clinical breakpoints from the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Respiratory isolates predominated (proportion: 24/30). The 30 isolates included one serotype f isolate, while the remaining 29 lacked polysaccharide capsule genes. Resistance to extended-spectrum cephalosporins (cefixime, 29 isolates/30 isolates; cefepime, 28/30; cefotaxime, 26 /30; ceftaroline, 26/30; ceftriaxone, 14/30), beta-lactamase production (11/30) and co-resistance to non-beta-lactams (trimethoprim-sulfamethoxazole, 13/30; tetracycline, 4/30; chloramphenicol, 4/30; ciprofloxacin, 3/30) was frequent. The N526K substitution in PBP3 was present in 23 of 30 isolates; these included a blood isolate which represents the first invasive S385T + N526K isolate reported from Europe. The L389F substitution, present in 16 of 30 isolates, coincided with higher beta-lactam MICs. Non-susceptibility to meropenem was frequent in S385T + L389F + N526K isolates (8/12). All 11 beta-lactamase positive isolates were TEM-1. Five clonal groups of two to 10 isolates with identical MLST-ftsI allelic profiles were observed, including the first reported high-rPBP3 clone with TEM-1 beta-lactamase and co-resistance to ciprofloxacin, tetracycline, chloramphenicol and trimethoprim-sulfamethoxazole. Prior to this study, no multidrug resistant high-rPBP3 H. influenzae had been reported in Norway. Intensified surveillance of antimicrobial resistance is needed to guide empiric therapy.

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Section: Figurementioning

confidence: 56%

Emergence of clonally related multidrug resistant Haemophilus influenzae with penicillin-binding protein 3-mediated resistance to extended-spectrum cephalosporins, Norway, 2006 to 2013

et al. 2014

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“…In contrast to previous outbreak reports, in this outbreak, a BLNAR NTHi strain caused URI and spread rapidly among healthy healthcare workers. [22][23][24] Smoking and underlying respiratory diseases are also associated with NTHi infections among adults; however, this association was not observed in the current outbreak. The explanation for the differences in disease severity and transmissibility in this BLNAR NTHi outbreak and previous outbreaks might be 2-fold.…”

Section: Discussionmentioning

confidence: 60%

Nosocomial Outbreak of Upper Respiratory Tract Infection With β-Lactamase-Negative Ampicillin-Resistant Nontypeable Haemophilus influenzae

Miyahara

Suzuki

Morimoto

et al. 2018

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo describe the epidemiologic features of an outbreak of an acute respiratory tract infection (ARI) caused by β-lactamase-negative ampicillin-resistant (BLNAR) nontypeable Haemophilus influenzae (NTHi) in an acute-care ward.DESIGNCross-sectional case-control study.SETTINGAn acute-care ward (ward A) in a general hospital of Kochi in western Japan.METHODSPatients who shared a room with an index patient and all staff in ward A were screened and followed from July 1 to August 31, 2015. Sputum or throat swab samples were collected from participants and tested by culture and polymerase chain reaction (PCR). The association between detected pathogens and ARI development among all participants was examined. A case-control study was conducted to identify risk factors for disease.RESULTSIn total, 78 participants, including the index patient, were enrolled. Of all participants, 27 (34.6%) developed mild respiratory symptoms during a 3-week period: 24 were diagnosed as upper respiratory tract infections, and 3 were diagnosed as lower respiratory tract infections. The presence of BLNAR NTHi was confirmed in 13 participants, and multilocus sequence typing demonstrated that these isolates belonged to sequence type 159. All isolates showed identical pulsed-field gel electrophoresis patterns. The presence of BLNAR NTHi was strongly associated with ARI development, whereas viruses were not associated with the disease. Multivariate analyses demonstrated that a history of contact with the index patient was independently associated with ARI caused by BLNAR NTHi.CONCLUSIONSBLNAR NTHi has the potential to cause upper respiratory tract infections among adults and to spread rapidly in hospital settings.Infect Control Hosp Epidemiol 2018;39:652-659.

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“…The epidemiology of these outbreaks was studied by procedures as widely divergent as serotyping, biotyping, multilocus enzyme electrophoresis, major outer membrane protein profiling, and direct DNAmediated typing procedures. Sometimes strains can be tracked down quite easily due to the presence of antibiotic resistance markers (8). We present here another example of an outbreak due to H. influenzae serotype b carrying a clear antibiotic resistance marker: amoxicillin resistance.…”

Section: Discussionmentioning

confidence: 99%

Outbreak of amoxicillin-resistant Haemophilus influenzae type b: variable number of tandem repeats as novel molecular markers

et al. 1997

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An outbreak caused by amoxicillin-resistant Haemophilus influenzae type b was noted among patients suffering from chronic obstructive pulmonary disease. Since infections were clustered in time and place, an ongoing outbreak was suspected. The spread of the strain and the course of the outbreak could be followed by random amplification of polymorphic DNA (RAPD) analysis of the different bacterial isolates. In addition, studies were aimed at the determination of length polymorphism in regions of repetitive DNA. By PCRmediated amplification of variable number of tandem repeat regions (VNTRs), additional insight into the genome composition of the epidemic strain was gained. Our results show that VNTRs comprising repeat units that are 3, 5, or 6 nucleotides in length provided stable genetic markers that can be used for molecular typing of H. influenzae type b. VNTRs built from tetranucleotide units, however, appear to be hypervariable and not suited for epidemiological studies. The observed variability in this latter class of VNTRs might be reminiscent of the bacterium's capacity to deal with unfavorable host factors.

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A nosocomial outbreak of amoxycillin-resistant non-typable Haemophilus infiuenzae in a respiratory ward

Cited by 9 publications

References 19 publications

Emergence of clonally related multidrug resistant Haemophilus influenzae with penicillin-binding protein 3-mediated resistance to extended-spectrum cephalosporins, Norway, 2006 to 2013

Emergence of clonally related multidrug resistant Haemophilus influenzae with penicillin-binding protein 3-mediated resistance to extended-spectrum cephalosporins, Norway, 2006 to 2013

Nosocomial Outbreak of Upper Respiratory Tract Infection With β-Lactamase-Negative Ampicillin-Resistant Nontypeable Haemophilus influenzae

Outbreak of amoxicillin-resistant Haemophilus influenzae type b: variable number of tandem repeats as novel molecular markers

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