JAC Advance Access originally published online on November 12, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 961-966
© 2003 The British Society for Antimicrobial Chemotherapy
Antibiotic resistance and clinical significance of Haemophilus influenzae type f
1 Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ministry of Health, 28220 Majadahonda, Madrid; 2 Servicio de Microbiología, Hospital Gregorio Marañón, Madrid, Spain
Received 4 July 2003; returned 27 September 2003; revised 30 September 2003; accepted 3 October 2003
Objectives: Little is known about the antibiotic susceptibility and clinical significance of non-type b capsulated Haemophilus influenzae. We studied the antibiotic resistance patterns, plasmid carriage and clinical features of H. influenzae type f infections in Spain during 1996–2002.
Patients and methods: Forty-nine H. influenzae type f recovered from Spanish hospitals were analysed at a central laboratory where full microbiological and molecular epidemiological studies were carried out. Antimicrobial susceptibility testing was performed in accordance with NCCLS guidelines.
Results: Twelve strains (24.5%) were resistant to ampicillin and 22 (44.9%) to co-trimoxazole. Decreased susceptibility to clarithromycin, tetracycline, chloramphenicol and rifampicin was found in 16.3%, 12.2%, 14.3% and 2% of strains, respectively. Multidrug resistance was present in nine (18.4%) of the 49 isolates. The most prevalent resistance phenotype was ampicillin/tetracycline/co-trimoxazole/chloramphenicol, which was detected in five isolates. All six strains that were simultaneously resistant to ampicillin, tetracycline and chloramphenicol had conjugative plasmids. The main clinical diagnoses were pneumonia (32.6%), sepsis (18.4%) and meningitis (16.3%). Thirty-two patients (65.3%) had previous underlying predisposing conditions, principally respiratory diseases (20.4%). Twenty-one patients (42.8%) had impaired immunity. Thirty-seven (75.5%) patients were >14 years old, 12 (24.5%) were 
14 years, and seven were 5 years. Most isolates were clonally related.
Conclusions: A high prevalence of antibiotic resistance, including multiresistance, was detected in Spanish H. influenzae type f isolates. Carriage of large conjugative plasmids was strongly associated with antibiotic resistance. H. influenzae type f is mainly an opportunistic pathogen, although it may cause primary severe infections, such as meningitis in children.
Keywords: H. influenzae, plasmid carriage, opportunistic infections
* Corresponding author. Tel: +34-91-822-36-50; Fax: +34-91-509-79-66; E-mail: jcampos{at}isciii.es
Members of the Spanish Study Group for H. influenzae type f are listed in the Acknowledgements.
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