TEM-1 AND ROB-1 PRESENCE AND ANTIMICROBIAL RESISTANCE IN HAEMOPHILLIS INFLUENZAE STRAINS, ISTANBUL, TURKEY

Abstract

Resistance of 235 Haemophilus influenzae clinical isolates from Istanbul Medical Faculty Hospital, Turkey were determined against 19 antibiotics by disc diffusion method, and minimum inhibitory concentrations (MICs) of those found resistant to ampicillin, cefuroxim, chloramphenicol and meropenem were measured using E-test. Ampicillin-resistant isolates producing beta-lactamase as demonstrated by a nitrocefin assay were analyzed for the presence of TEM-1 and ROB-1 genes by PCR. Eleven percent of the isolates were resistant to ampicillin (10 mu g/ml), of which 73% were beta-lactamase positive and carried TEM-1 gene, but none were positive for ROB-1 gene. All isolates susceptible to amoxicillin-clavulanate (20/10 mu g/ml), azithromycin (15 mu g/ml), aztreonam (30 mu g/ml), cefotaxime (30 mu g/ml), ceftriaxone (30 mu g/ml), ciprofloxacin (5 mu g/ml) levofloxacin (5 mu g/ml), and telithromycin (15 mu g/ml) but 24%, 15%, 4%, 4%, 2%, 1%, 1%, 0.5%, 0.5% and 0.5% were resistant to trimethoprim-sulfamethoxazole (1.25/23.75 mu g/ml), tetracycline (30 mu g/ml), cefaclor (30 mu g/ml), clarithromycin (15 mu g/ml), cefuroxime (30 mu g/ml), meropenem (10 mu g/ml), chloramphenicol (30 mu g/ml), ampicillin-sulbactam (10/10 mu g/ml), nalidixic acid (30 mu g/ml), and fosfomycin (30 mu g/ml), respectively. MIC values of three cefuroxime-resistant isolates was 24, 48 and > 256 mu g/ml, respectively; of two meropenem-resistant strains > 256 mu g/ml; and of two chloramphenicol-susceptible isolates (by disc diffusion method) 6 mu g/ml (considered as intermediate susceptible). Multiple-antibiotics resistance was detected in 15% of the strains, with resistance to 2, 3, 4, 5 and 6 antibiotics in 8.5%, 4%, 2%, 0.5% and 0.5% of the isolates, respectively. By identifying beta-lactamase-negative ampicillin-resistant H. influenzae, empirical therapy with beta-lactam/beta-lactamase inhibitor combinations and second generation cephalosporins would be inappropriate for such patients (approximately 3%). Our findings will contribute to the epidemiological and clinical data regarding H. influenzae infection in Turkey.