{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:24:16Z","timestamp":1777922656017,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2013,2,1]],"date-time":"2013-02-01T00:00:00Z","timestamp":1359676800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2013,2]]},"abstract":"<jats:p>\n                    We report the emergence of a multidrug-resistant\n                    <jats:italic toggle=\"yes\">Haemophilus influenzae<\/jats:italic>\n                    strain in a patient with common variable immunodeficiency suffering from recurrent bronchopneumonia caused by\n                    <jats:italic toggle=\"yes\">H. influenzae<\/jats:italic>\n                    . After the patient had received several antibiotic therapies, a strain was isolated showing resistance to ampicillin, ampicillin\/sulbactam, cefazolin, cefuroxime, ciprofloxacin, and clarithromycin. Polymerase chain reaction analyses and sequencing revealed the presence of the beta-lactamase gene\n                    <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                    <jats:sub>TEM-1<\/jats:sub>\n                    , two mutations (A502T and R517H) in the\n                    <jats:italic toggle=\"yes\">ftsI<\/jats:italic>\n                    gene encoding the transpeptidase region of the penicillin-binding protein 3, and one mutation in the ribosomal protein gene\n                    <jats:italic toggle=\"yes\">L4<\/jats:italic>\n                    (G65D) conferring resistance to beta-lactams and macrolides, respectively. Additionally, the plasmid-encoded\n                    <jats:italic toggle=\"yes\">aac(6\u2032)-Ib-cr<\/jats:italic>\n                    gene mediating slightly reduced susceptibility to quinolones and two mutations in the DNA gyrase gene\n                    <jats:italic toggle=\"yes\">gyrA<\/jats:italic>\n                    and one mutation in the topoisomerase IV gene\n                    <jats:italic toggle=\"yes\">parC<\/jats:italic>\n                    were identified leading to a high-level fluoroquinolone-resistant phenotype. In conclusion, the treatment of\n                    <jats:italic toggle=\"yes\">H. influenzae<\/jats:italic>\n                    infections accompanied by high bacterial loads such as bronchopneumonia can be complicated by the selection of multidrug-resistant strains. Moreover, the emergence of\n                    <jats:italic toggle=\"yes\">aac(6\u2032)-Ib-cr<\/jats:italic>\n                    in\n                    <jats:italic toggle=\"yes\">H. influenzae<\/jats:italic>\n                    causing low fluoroquinolone resistance levels might have contributed to the selection of DNA gyrase and topoisomerase IV mutants.\n                  <\/jats:p>","DOI":"10.1089\/mdr.2012.0060","type":"journal-article","created":{"date-parts":[[2012,10,24]],"date-time":"2012-10-24T11:21:08Z","timestamp":1351077668000},"page":"1-5","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Emergence of a Multidrug-Resistant\n                    <i>Haemophilus influenzae<\/i>\n                    Strain Causing Chronic Pneumonia in a Patient with Common Variable Immunodeficiency"],"prefix":"10.1177","volume":"19","author":[{"given":"Yvonne","family":"Pfeifer","sequence":"first","affiliation":[{"name":"Robert-Koch-Institute","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ines","family":"Meisinger","sequence":"additional","affiliation":[{"name":"University of T\u00fcbingen","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Brechtel","sequence":"additional","affiliation":[{"name":"University of T\u00fcbingen","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabine","family":"Gr\u00f6bner","sequence":"additional","affiliation":[{"name":"Eberhard Karls University of T\u00fcbingen","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2013,2]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1093\/jac\/dkq533","article-title":"Polymorphism in ftsI gene and \u03b2-lactam susceptibility in Portuguese Haemophilus influenzae strains: clonal dissemination of \u03b2-lactamase-positive isolates with decreased susceptibility to amoxicillin\/clavulanic acid","volume":"66","author":"Barbosa A.R.","year":"2011","unstructured":"Barbosa A.R., , Giufre M., , Cerquetti M., , Bajanca-Lavado M.P. 2011. Polymorphism in ftsI gene and \u03b2-lactam susceptibility in Portuguese Haemophilus influenzae strains: clonal dissemination of \u03b2-lactamase-positive isolates with decreased susceptibility to amoxicillin\/clavulanic acid. J. Antimicrob. Chemother., 66:788\u2013796.","journal-title":"J. Antimicrob. Chemother."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0732-8893(03)00016-6"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","first-page":"2956","DOI":"10.1128\/AAC.46.9.2956-2962.2002","article-title":"In vitro selection of resistance in Haemophilus influenzae by amoxicillin-clavulanate, cefpodoxime, cefprozil, azithromycin, and clarithromycin","volume":"46","author":"Clark C.","year":"2002","unstructured":"Clark C., , Bozdogan B., , Peric M., , Dewasse B., , Jacobs M.R., , Appelbaum P.C. 2002. In vitro selection of resistance in Haemophilus influenzae by amoxicillin-clavulanate, cefpodoxime, cefprozil, azithromycin, and clarithromycin. Antimicrob. 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