[Case of pneumonia caused by beta-lactamase-producing and amoxicillin/clavulanate resistant strains of H. influenzae].

Abstract

An 80-year-old woman presenting with fever and cough was given a diagnosis of community-acquired pneumonia. She was hospitalized and treated with ampicillin/sulbactam (ABPC/SBT) and clarithromycin (CAM). Gram stain images and sputum culture results led us to believe that the causative agent was Haemophilus influenzae. Drug sensitivity testing indicated that the H. influenzae was a beta-lactamase-positive, ABPC-resistant (BLPAR) strain. Treatment with ABPC/SBT was not clinically effective. We considered the possibility of beta-lactamase-positive amoxicillin/clavulanate-resistant (BLPACR) strains. Further testing revealed that the MIC of ABPC was 128 microg/ml, that of SBT/ABPC was 8 microg/ml, and that of AMPC/CVA was 4 microg/ml. Furthermore, genetic analysis indicated the H. influenzae to be a BLPACR-I strain. The poor clinical course eventually led to a diagnosis of BLPACR. When beta-lactamase-producing H. influenzae is cultured, the possibility of a BLPACR strain resistant to ABPC/SBT and AMPC/CVA must be considered.

• Authors: Ryozo Yano, Noboru Takayanagi, Naho Kagiyama, Keiji Harasawa, Fumi Matusita, Kouichirou Yoneda, Yousuke Miyahara, Shouzaburo Yamaguchi, Daidou Tokunaga, Hiroo Saito, Kazuyoshi Kurashima, Mikio Ubukata, Tsutomu Yanagisawa, Yutaka Sugita
• Journal: Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society (Nihon Kokyuki Gakkai Zasshi) Vol. 46 Issue 9 Pg. 753-8 (Sep 2008) ISSN: 1343-3490 [Print] Japan
• PMID: 18939421 (Publication Type: Case Reports, Journal Article)

Chemical References

• Clavulanic Acid
• Ampicillin
• beta-Lactamases

Topics

• Aged, 80 and over
• Ampicillin (pharmacology)
• Clavulanic Acid (pharmacology)
• Community-Acquired Infections (diagnosis, drug therapy, microbiology)
• Female
• Haemophilus Infections (diagnosis, drug therapy, microbiology)
• Haemophilus influenzae (drug effects, enzymology, genetics, isolation & purification)
• Humans
• Pneumonia, Bacterial (diagnosis, drug therapy, microbiology)
• beta-Lactam Resistance
• beta-Lactamases (biosynthesis)