JAC Advance Access published online on April 14, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl142
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1 Laboratory of Infectious Agents Surveillance, Kitasato Institute for Life Sciences, Kitasato University, 5-9-1, Shirokane, Minato-ku, Tokyo, Japan
* To whom correspondence should be addressed. Objectives: To study yearly changes in resistance and to identify ftsI mutations in Methods: Between January 2000 and December 2004, we received 621 isolates of H. influenzae from 285 member institutions of the Nationwide Surveillance Study Group for Bacterial Meningitis. All isolates were analysed by PCR to identify resistance genes and tested for susceptibility to Results: All but four isolates were of serotype b. The isolates could be divided into six classes, namely Conclusions: The results suggest that introduction of H. influenzae type b (Hib) vaccination into infants and children is necessary for the prevention of severe Hib infections in Japan.
Received December 9, 2005
Revised March 13, 2006
Accepted March 20, 2006
Original article
High prevalence of type b
Keiko Hasegawa 1,
Reiko Kobayashi 1,
Emi Takada 1,
Akiko Ono 1,
Naoko Chiba 1,
Miyuki Morozumi 1,
Satoshi Iwata 2,
Keisuke Sunakawa 3,
Kimiko Ubukata 1 *,
and
on behalf of the Working Group of the Nationwide Surveillance for Bacterial Meningitis
-lactamase-non-producing ampicillin-resistant Haemophilus influenzae in meningitis: the situation in Japan where Hib vaccine has not been introduced
2 National Hospital Organization Tokyo Medical Center, Tokyo, Japan
3 Department of Infectious Disease, Kitasato University School of Medicine, Kanagawa, Japan
Kimiko Ubukata, E-mail: ubukatak{at}lisci.kitasato-u.ac.jp
Abstract 
-lactamase-non-producing ampicillin-resistant (BLNAR) and TEM-1 -lactamase-producing amoxicillin/clavulanic acid-resistant (BLPACR) isolates of Haemophilus influenzae from patients with meningitis.-lactams. The ftsI gene was sequenced in all BLNAR and BLPACR isolates.-lactamase-non-producing ampicillin-susceptible (25.0%), TEM-1 -lactamase-producing ampicillin-resistant (11.0%), -lactamase-non-producing low-level ampicillin-resistant with N526K or R517H substitution in the ftsI gene (30.4%), BLNAR with an S385T substitution together with either N526K or R517H substitution in ftsI (22.2%), BLPACR-I with either a N526K or R517H substitution in ftsI (9.5%) and BLPACR-II with an S385T substitution together with either a N526K or R517H substitution in ftsI (1.9%). The prevalence of BLNAR has increased rapidly, from 5.8% in 2000 to 34.5% in 2004. All BLNAR and BLPACR-II strains were classified into nine subgroups on the basis of substitution patterns in the ftsI gene. The MICs of cephalosporin antibiotics for H. influenzae transformants into which the ftsI genes from BLNAR strains of each of the nine subgroups were introduced increased to varying degrees depending on the mutations.
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