17Among drug-resistant bacteria of recent concern, we determined minimum inhibitory 18 concentrations (MICs) of six different quinolone antibacterial agents in Haemophilus 19 influenzae and performed molecular genetic analysis in addition to the exploration for 20 β-lactamase-producing and β-lactamase negative ampicillin-resistant H. influenzae 21 (BLNAR). A total of 144 clinical H. influenzae strains isolated at the Showa University 22 Hospital between 2012 and 2017 were subjected to MIC determination for 23 penicillin/quinolone antibacterial agents using the nitrocefin method and the Clinical 24 and Laboratory Standards Institute broth microdilution method. Moreover, amino acid 25 mutations in the quinolone resistance-determining regions (QRDRs) were analyzed in 26 the isolates showing MIC value of ≥ 0.25 µg/ml of quinolone antibacterial agents.
27Increasing proportions of BLNAR were noted, with 15% in 2015 to 43.5% in 2016 and 28 63.6% in 2017. Among quinolone antibacterial agents, all isolates remained susceptible 29 to sitafloxacin (STFX), and STFX showed strong inhibitory potencies against both 30 DNA gyrase and topoisomerase IV. For moxifloxacin (MXF), however, strains with 31 MIC value of 0.5 µg/ml were detected every year since 2013 except 2015. Amino acid 32 mutations were investigated in 17 isolates (11.8%) with MXF MIC value of ≥0.25 33 µg/ml, and confirmed in 11 isolates (7.6%), of which mutations of GyrA were found in 34 3 3 9 isolates. Future antibacterial drug regimens may need to address the emergence of 35 quinolone-resistant H. influenzae. 36 37 38 4 4 Introduction 39 Haemophilus influenzae is the second most common causative bacterium of 40 community-acquired pneumonia, following Streptococcus pneumoniae, and has taken 41 the leading position after pneumococcal vaccines became popular (1). β-Lactam 42 antibiotics have previously been used for the treatment of community-acquired 43 pneumonia. In the 2000s, however, β-lactamase producing ampicillin-resistant (BLPAR) 44 bacteria have been increasingly detected in Canada (2), Japan, and some other countries. 45 In addition, β-lactamase negative ampicillin-resistant (BLNAR) bacteria have been 46 increasingly detected in Japan in the recent years (3). Moreover, BLNAR bacteria 47 65 GyrA gene encoding DNA gyrase or ParC gene encoding topoisomerase IV, which 66 cause three-dimensional structural alterations in the respective enzymes and decrease 67 the affinity between fluoroquinolones and these replication enzymes (9). In the case of 68 H. influenzae, drug resistance has been shown to be strongly related to mutations of 69 serine and aspartic acid at positions 84 and 88 of GyrA and of serine at position 84 of 70 ParC (10). However, only a limited number of previous studies have investigated 71 mutations in QRDRs in the same institution over time or have compared MICs among 72 different quinolones.In this study, we tested sensitivity levels to quinolone and 73 penicillin antibacterial agents over 6 years in H. influenzae strains that were isolated at ...