Antimicrobial susceptibility of Haemophilus influenzae strains isolated from the urethra of men with acute urethritis and/or epididymitis

doi:10.1016/j.jiac.2017.05.009

Journal of Infection and Chemotherapy

Volume 23, Issue 11, November 2017, Pages 804-807

https://doi.org/10.1016/j.jiac.2017.05.009 Get rights and content

Abstract

We determined minimum inhibitory concentrations (MICs) of 41 antimicrobial agents for 73 clinical strains of Haemophilus influenzae isolated from the urethra of men with acute urethritis and/or epididymitis and examined the strains for the production of β-lactamase. We also compared their antimicrobial susceptibilities with those of H. influenzae strains from respiratory tract or otorhinolaryngological infections that were reported in Japan. The proportion of β-lactamase-nonproducing ampicillin-resistant strains from acute urethritis and/or epididymitis appeared to be lower, but that of β-lactamase-producing ampicillin-resistant strains appeared to be higher, compared with those from respiratory tract or otorhinolaryngological infections. However, their antimicrobial susceptibilities to a variety of other antimicrobial agents would be similar to those from respiratory tract or otorhinolaryngological infections. Almost all of the strains of H. influenzae from acute urethritis and/or epididymitis were susceptible to the agents, including ceftriaxone, quinolones, macrolides, and tetracyclines, commonly prescribed for treatment of acute urethritis based on the MIC breakpoints recommended by the Clinical and Laboratory Standards Institute. Ceftriaxone and quinolones could be effective on H. influenzae-induced urethritis. However, azithromycin treatment failures were reported in acute urethritis caused by H. influenzae strains considered susceptible to azithromycin. Further studies will be needed to determine MIC breakpoints of antimicrobial agents, which are recommended for treatment of urogenital infections, for H. influenzae strains causing these infections. Nevertheless, this study provides useful data regarding antimicrobial susceptibilities of H. influenzae strains isolated from the urogenital tract, which have rarely been studied.

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Conflict of interest

The authors have no conflicts of interest to disclose.

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Cited by (19)

Isolation of Haemophilus no ducreyi in samples from the genital tract of men: Its clinical relationship
2023, Revista Internacional de Andrologia
Con el avance de los métodos microbiológicos, cada vez es más frecuente el aislamiento de patógenos menos típicos en cuadros de infección uretral y rectal, además de los agentes etiológicos clásicos. Uno de ellos está formado por especies de Haemophilus no ducreyi (HND). El objetivo de este trabajo es describir la frecuencia, la sensibilidad antibiótica y las características clínicas de las uretritis y proctitis por HND en varones.
Se realizó un estudio observacional descriptivo y retrospectivo, a partir de los resultados emitidos por el Laboratorio de Microbiología del Hospital Universitario Virgen de las Nieves de Granada, de los aislamientos, entre 2016 y 2019, de HND en episodios infecciosos genitales y rectales de varones adultos.
Se aisló HND en 135 (7%) episodios. La especie más frecuente fue H. parainfluenzae (34/45; 75,6%). Los síntomas más frecuentes de las proctitis fueron: tenesmo rectal (31,6%) y adenopatías (10,5%); en aquellos con uretritis, fueron disuria (71,6%), supuración uretral (46,7%) y lesiones en el glande (27%), siendo manifestaciones similares a las infecciones provocadas por los genitopatógenos habituales. Un 43% de los pacientes eran VIH positivos. Las tasas de resistencia a antibióticos de H. parainfluenzae fueron elevadas a levofloxacino, ampicilina, tetraciclina y azitromicina.
Las especies de HND deberían tenerse en cuenta como posibles agentes etiológicos en episodios de infección uretral y rectal en varones, sobre todo en los casos con pruebas de detección negativas para agentes productores habituales de infecciones de transmisión sexual. Su detección microbiológica es fundamental para la instauración de un tratamiento efectivo dirigido.
With the advancement of microbiological methods, the isolation of less typical pathogens in cases of urethral and rectal infection is more frequent, apart from the classic etiological agents. One of them is formed by species of Haemophilus no ducreyi (HND). The objective of this work is to describe frequency, susceptibility to antibiotics, and clinical features of HDN urethritis and proctitis in adult males.
This is an observational retrospective descriptive study of the results obtained by the Microbiology laboratory of the Virgen de las Nieves University Hospital on the isolates of HND in genital and rectal samples from males between 2016 and 2019.
HND was isolated in 135 (7%) of the genital infection episodes diagnosed in men. H. parainfluenzae was the most commonly isolated (34/45; 75.6%). The most frequent symptoms in men with proctitis were rectal tenesmus (31.6%) and lymphadenopathy (10.5%); in those with urethritis, dysuria (71.6%), urethral suppuration (46.7%) and gland lesions (27%), so differentiating it from infections caused by other genitopathogens is difficult. 43% of patients were HIV positive. Antibiotic resistance rates for H. parainfluenzae were high to quinolons, ampicillin, tetracycline and macrolides.
HND species should be considered as possible etiologic agents in episodes of urethral and rectal infection in men, especially in cases with negative screening tests for agents that cause sexually transmitted infections (STIs). Its microbiological identification is essential for the establishment of an effective targeted treatment.
Importance of the role of Haemophilus no ducreyi isolates in female genital tract and its clinical relationship
2023, Clinica e Investigacion en Ginecologia y Obstetricia
Cada vez son más frecuentes los informes microbiológicos con agentes emergentes en episodios clínicos del aparato genital de sujetos con sospecha de infección, como son las especies de Haemophilus no ducreyi (HND). El objetivo de este trabajo es analizar la importancia clínica del aislamiento de estas especies en el tracto genital del sexo femenino.
Se realizó un estudio observacional descriptivo y retrospectivo en un hospital universitario del sudeste español, donde se evalúan los aislamientos de HND en muestras de exudados genitales femeninos procedentes de atención sanitaria especializada entre 2016 y 2019. Se analizaron variables clínicas, epidemiológicas y microbiológicas de los episodios infecciosos de mujeres adultas y niñas.
Se encontraron 45 (25 mujeres y 20 niñas) aislamientos de HND, correspondiendo al 1% del total, siendo la especie más frecuente Haemophilus influenzae (64,4%). En mujeres predominaron la leucorrea y el dolor abdominal, y en el 72% hubo aislamiento polimicrobiano. En niñas se aisló frecuentemente de forma aislada, con presencia de eritema vulvovaginal, flujo patológico y prurito local. Destacó la alta tasa de resistencia de Haemophilus parainfluenzae a azitromicina (72,7%) y cotrimoxazol (18,2%) en mujeres adultas, y la resistencia a azitromicina en niñas (25%).
H. influenzae y H. parainfluenzae deben tenerse en cuenta como posible agente etiológico en casos de vaginitis y cervicitis en mujeres adultas, así como en sospecha de enfermedad pélvica inflamatoria. En niñas, H. influenzae representa uno de los agentes microbiológicos de las infecciones vulvovaginales. La tasa de resistencia a azitromicina de H. parainfluenzae y a cotrimoxazol de ambas especies se debe tener presente.
The isolation of new pathogens in clinical samples from the genital tract of subjects with suspected infection, such as Haemophilus no ducreyi (HND) species, is becoming more frequent. The objective of this work is to analyze the pathogenic role and the clinical importance of the isolation of these species in female genital tract.
We carried out an observational, descriptive, and retrospective study from a Hospital in Granada (Spain). HND isolates in female genital samples between 2016 and 2019 from specialized care were studied. Clinical, epidemiological, and microbiological variables of clinical episodes of adult women and girls were analyzed.
Forty-five (25 women and 20 girls) isolates of HND were found, corresponding to 1%; the most frequent specie was Haemophilus influenzae (64.4%). In women, leukorrhea and abdominal pain was frequent and in 72% there was a polymicrobial isolate. In girls, it was frequently in isolation, with the presence of vulvovaginal erythema, pathological discharge, and local itching. We highlight the high rate of resistance of Haemophilus parainfluenzae to azithromycin (72.7%) and cotrimoxazole (18.2%) in adult women, in contrast to resistance to azithromycin in girls (25%).
H. influenzae and H. parainfluenzae should be considered as a possible etiological agent in cases of vaginitis and cervicitis in adult women, as well as in suspected pelvic inflammatory disease. In girls, H. influenzae represents one of the microbiological agents within the etiologies of vulvovaginal infections. We highlight the rate of resistance to azithromycin in H. parainfluenzae and to cotrimoxazole in both species.
Clinical significance of isolation of Haemophilus no ducreyi in genital samples. Systematic review
2023, Enfermedades Infecciosas y Microbiologia Clinica
Actualmente el diagnóstico microbiológico de las infecciones genitales se realiza con métodos moleculares, los cuales permiten detectar agentes etiológicos menos frecuentes, pero con potencial importancia patogénica, como Haemophilus spp. El objetivo de esta revisión es analizar y resaltar la importancia clínica del aislamiento de Haemophilus spp. en infecciones genitales y rectales, excluyendo H. ducreyi.
Se ha realizado una revisión sistemática en base a una búsqueda exhaustiva de las publicaciones incluidas en la base de datos MEDLINE hasta el 5 de agosto de 2021, sobre la presencia de Haemophilus spp. en infecciones genitales y rectales, excluyendo H. ducreyi.
Tras revisar lo descrito en la literatura, las especies de Haemophilus (excluyendo H. ducreyi: HSNOD) se detectaron en 2397 episodios de infección genital, siendo las especies más frecuentemente aisladas H. influenzae y H. parainfluenzae. La mayoría de los episodios (87,6%) están constituidos por aislamiento único. Existe un ligero predominio en mujeres (48,3%) donde puede producir cuadros de vaginitis, salpingitis, endometritis o complicaciones durante el embarazo. En hombres, el cuadro clínico suele corresponder a una uretritis. La mayoría de las muestras corresponde a exudados vaginales y uretrales, con una representación minoritaria a nivel rectal (2,3%).
HSNOD desempeña un papel patogénico relevante en episodios de infección genital, por lo que los protocolos de diagnóstico microbiológico deben incluir métodos que permitan su detección, así como incluirlos en el espectro etiológico de este tipo de cuadros clínicos.
Currently, the microbiological diagnosis of genital infections is carried out with molecular methods, which allow the detection of less frequent etiological agents but with potential pathogenic importance, such as Haemophilus spp. The objective of this review is to analyze and highlight the clinical importance of the isolation of Haemophilus spp. in genital and rectal infections, excluding H. ducreyi.
A systematic review was carried out based on an exhaustive search of the publications included in the MEDLINE database up to August 5, 2021, on the presence of Haemophilus spp. in genital and rectal infections, excluding H. ducreyi.
After reviewing what was described in the literature, Haemophilus spp. (excluding H. ducreyi: HSNOD) was detected in 2397 episodes of genital infection, the most frequently isolated species being H. influenzae and H. parainfluenzae. Most of the episodes (87.6%) are constituted by single isolation. There is a slight predominance in women (48.3%) where it can cause vaginitis, salpingitis, endometritis or complications during pregnancy. In men, the clinical picture usually corresponds to urethritis. Most of the samples correspond to vaginal and urethral exudates, with a minority representation at the rectal level (2.3%).
HSNOD plays a relevant pathogenic role in episodes of genital infection, so microbiological diagnostic protocols must include methods that allow their detection, as well as include them in the etiological spectrum of this type of clinical picture.
Antimicrobial resistance of Haemophilus influenzae isolates from pediatric hospitals in Mainland China: Report from the ISPED program, 2017–2019
2021, Indian Journal of Medical Microbiology
Citation Excerpt :
However, even in the same region, antibiotic resistance profiles of H. influenzae vary greatly among different infection sites. There were significant differences of the proportion of BLNAR strains of H. influenzae between respiratory and urinary specimens in a Japanese study [26]. The resistance rates to antibiotics were significantly different between respiratory isolates and vaginal isolates in previous study of ISPED [13].
This study set out to determine the antimicrobial resistance trends of Haemophilus influenzae isolates from pediatric hospitals in Mainland China, which would provide basis for clinical treatment.
The Infectious Disease Surveillance of Pediatrics (ISPED) collaboration group conducted this study. H. influenzae strains isolated from nine pediatric hospitals in Mainland China were included. Disk diffusion method was used for antimicrobial susceptibility test. Cefinase disc was used for detection of β-lactamase.
In total, 13810 H. influenzae isolates were included during 2017–2019: 93.17% of which were from respiratory tract specimens, 4.63% from vaginal swabs, 1.10% from secretion, and 1.10% from others. Of all strains, 63.32% isolates produced β-lactamase; 8.22% isolates were β-lactamase-negative and ampicillin-resistant (BLNAR). The resistance to sulfamethoxazole-trimethoprim was 70.98%, followed by resistance to ampicillin (69.37%), cefuroxime (51.35%), ampicillin-sulbactam (38.82%), azithromycin (38.21%), amoxicillin-clavulanate (35.28%). More than 90% of H. influenzae isolates were susceptible to ceftriaxone, cefotaxime, meropenem, levofloxacin and chloramphenicol. The resistance rate of ampicillin and azithromycin in H. influenzae showed an increasing trend through the years. Statistically significant differences in antibiotic-resistance rates of all the antibiotics except chloramphenicol were found in different regions. The major Multi-Drug Resistance pattern was resistant to β-lactams, macrolides, and sulfonamides.
There is a rising trend of resistance rate of ampicillin and azithromycin in H. influenzae. Antimicrobial resistance of H. influenzae deserves our ongoing attention. Third-generation cephalosporin could be the preferred treatment option of infections caused by ampicillin-resistant H. influenzae.
Haemophilus urethritis in males: A series of 30 cases
2021, Revista Internacional de Andrologia
Citation Excerpt :
Both Haemophilus influenzae and Haemophilus parainfluenzae are colonizers of the upper respiratory tract and are part of the normal oral microflora.4,5 They are not only commensal within the pharynx but also pathogens causing various infections, mainly in relation to the respiratory tract.6 Sexual transmission of both has been described.
Pathogens such as Haemophilus spp. have been associated with non-gonococcal urethritis, but their role is unproven. To describe the clinical characteristics and therapeutic outcomes in male patients diagnosed with Haemophilus spp. urethritis.
We carried out a retrospective study of all patients who presented to our hospital (in either the emergency department or the outpatient clinic) between July 2016 and April 2018 in whom Haemophilus spp. was isolated in the urethral samples. We enrolled 30 men with Haemophilus spp.-positive urethritis, including coinfections with Neisseria gonorrhoeae and Chlamydia trachomatis. Clinical, laboratory, demographic, and behavioral data were obtained by reviewing medical histories.
The mean age of the patients was 36.6 years (range 21–87). Seventeen patients (63%) reported being exclusively heterosexual. Three patients (10%) were HIV infected, all of them with an undetectable viral load. The most common clinical presentation was mucopurulent urethral discharge, in 13 patients (43%). The antibiotic treatment achieved a complete clinical resolution in 73%.
Haemophilus urethritis affected men regardless of their sexual orientation or HIV status. Unprotected oral sex may play a role in its transmission. The limitations of the study preclude verification of the pathogenic role of Haemophilus spp. in acute urethritis, but clinical response after antibiotic treatment suggests that Haemophilus spp. can play such a role.
Patógenos como Haemophilus spp. se han asociado con uretritis no gonocócica, pero su papel no está probado. El objetivo de nuestro trabajo ha sido describir las características clínicas y los resultados terapéuticos en varones diagnosticados de uretritis de Haemophilus spp.
Realizamos un estudio retrospectivo de todos los pacientes que se presentaron en nuestro hospital (ya sea en el departamento de emergencias o en la clínica ambulatoria) entre julio del 2016 y abril del 2018 en quienes Haemophilus spp. se aisló en las muestras uretrales. Se incluyó a30 hombres con uretritis positiva para Haemophilus spp., incluidas las coinfecciones con Neisseria gonorrhoeae y Chlamydia trachomatis. Los datos clínicos, de laboratorio, demográficos y de comportamiento se obtuvieron al revisar las historias clínicas.
La edad media de los pacientes fue de 36,6 años (rango 21-87). Diecisiete pacientes (63%) informaron ser exclusivamente heterosexuales. Tres pacientes (10%) estaban infectados por el VIH, todos ellos con una carga viral indetectable. La presentación clínica más común fue secreción uretral mucopurulenta, en 13 pacientes (43%). El tratamiento antibiótico logró una resolución clínica completa en el 73%.
La uretritis por Haemophilus afectó a los hombres independientemente de su orientación sexual o estado de VIH. El sexo oral sin protección puede desempeñar un papel en su transmisión. Las limitaciones del estudio impiden la verificación del papel patogénico de Haemophilus spp. en uretritis aguda, pero la respuesta clínica después del tratamiento con antibióticos sugiere que Haemophilus spp. puede desempeñar ese papel.
Haemophilus spp., an emerging multidrug-resistant sexually transmitted pathogen
2020, Medecine et Maladies Infectieuses
Citation Excerpt :
The production of beta-lactamase is more important in urethral samples than in lower or upper respiratory tract samples [13]. Most of the resistance data comes from Japanese publications [6,8,9,13,14]. Compared to them, our strains are more frequently resistant to amoxicillin, tetracycline, third-generation cephalosporins, and fluoroquinolones.
To describe the characteristics of patients with a positive urethral sample for Haemophilus spp.
We performed a retrospective study from January 2018 to July 2019 at the Bordeaux university hospital (France) of all urethral samples positive for Haemophilus spp.
Haemophilus spp. was isolated in 10 urethral samples from nine patients. The mean age was 33.8 years. Most patients reported having unprotected sex. Haemophilus parainfluenzae was isolated in nine samples, and Haemophilus influenzae in one sample. Antibiotic susceptibility tests were performed in five samples; Haemophilus spp. was always resistant to amoxicillin and tetracycline. One patient had persistent symptoms after treatment for a multidrug-resistant Haemophilus parainfluenzae strain.
Haemophilus spp. is a rare pathogen of urethritis. Its responsibility should be considered in case of persistent symptoms. The emergence of multidrug-resistant Haemophilus spp. is becoming problematic.

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^☆: All authors have substantially contributed to this study and meet the ICMJE authorship criteria.

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References (20)

The first nationwide surveillance of bacterial respiratory pathogens conducted by the Japanese Society of Chemotherapy. Part 1: a general view of antibacterial susceptibility

J Infect Chemother

Nationwide surveillance of bacterial respiratory pathogens conducted by the Japanese Society of Chemotherapy in 2007: general view of the pathogens' antibacterial susceptibility

J Infect Chemother

Nationwide surveillance of bacterial respiratory pathogens conducted by the Japanese Society of Chemotherapy in 2008: general view of the pathogens' antibacterial susceptibility

J Infect Chemother

Nationwide surveillance of bacterial respiratory pathogens conducted by the surveillance committee of Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Clinical Microbiology in 2009: general view of the pathogens' antibacterial susceptibility

J Infect Chemother

Drug-resistant pathogen surveillance group in pediatric infectious disease. Nationwide survey of the development of drug resistance in the pediatric field in 2007 and 2010: drug sensitivity of Haemophilus influenzae in Japan (second report)

J Infect Chemother

Nationwide survey of the development of drug resistance in the pediatric field in 2000–2001, 2004, 2007, 2010, and 2012: evaluation of the changes in drug sensitivity of Haemophilus influenzae and patients' background factors

J Infect Chemother

Nationwide survey of the development of drug resistance in the pediatric field in 2007, 2010, and 2012: drug sensitivity of Haemophilus influenzae serotype b strain in Japan

J Infect Chemother

J Infect Chemother

Nationwide surveillance of 6 otorhinolaryngological infectious diseases and antimicrobial susceptibility pattern in the isolated pathogens in Japan

J Infect Chemother

Analysis of streptococcus pneumoniae and Haemophilus influenzae isolated from middle ear fluid before and after the introduction of government subsidies for pneumococcal and H. influenzae type b vaccines in Japan

J Infect Chemother

Cited by (19)

Isolation of Haemophilus no ducreyi in samples from the genital tract of men: Its clinical relationship

Importance of the role of Haemophilus no ducreyi isolates in female genital tract and its clinical relationship

Clinical significance of isolation of Haemophilus no ducreyi in genital samples. Systematic review

Antimicrobial resistance of Haemophilus influenzae isolates from pediatric hospitals in Mainland China: Report from the ISPED program, 2017–2019

Haemophilus urethritis in males: A series of 30 cases

Haemophilus spp., an emerging multidrug-resistant sexually transmitted pathogen

NoteAntimicrobial susceptibility of Haemophilus influenzae strains isolated from the urethra of men with acute urethritis and/or epididymitis☆

Abstract

Section snippets

Conflict of interest

J Infect Chemother

J Infect Chemother

J Infect Chemother

J Infect Chemother

J Infect Chemother

J Infect Chemother

J Infect Chemother

J Infect Chemother

J Infect Chemother

J Infect Chemother

Note
Antimicrobial susceptibility of Haemophilus influenzae strains isolated from the urethra of men with acute urethritis and/or epididymitis☆