{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:30:06Z","timestamp":1787941806204,"version":"build-2784847793"},"reference-count":32,"publisher":"American Society for Microbiology","issue":"11","license":[{"start":{"date-parts":[[2015,11,1]],"date-time":"2015-11-01T00:00:00Z","timestamp":1446336000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            <jats:named-content content-type=\"genus-species\">Haemophilus influenzae<\/jats:named-content>\n            is a major pathogen, and beta-lactams are first-line drugs. Resistance due to altered penicillin-binding protein 3 (rPBP3) is frequent, and susceptibility testing of such strains is challenging. A collection of 154 beta-lactamase-negative isolates with a large proportion of rPBP3 (67.5%) was used to evaluate and compare Etest (\n            <jats:named-content content-type=\"genus-species\">Haemophilus<\/jats:named-content>\n            test medium [HTM]) and disk diffusion (EUCAST method) for categorization of susceptibility to aminopenicillins and cefuroxime, using MICs generated with broth (HTM) microdilution and clinical breakpoints from CLSI and EUCAST as the gold standards. In addition, the proficiency of nine disks in screening for the rPBP3 genotype (N526K positive) was evaluated. By Etest, both essential and categorical agreement were generally poor (&lt;70%), with high very major errors (VME) (CLSI, 13.0%; EUCAST, 34.3%) and falsely susceptible rates (FSR) (CLSI, 87.0%; EUCAST, 88.3%) for ampicillin. Ampicillin (2 \u03bcg) with adjusted (+2 mm) zone breakpoints was superior to Etest for categorization of susceptibility to ampicillin (agreement, 74.0%; VME, 11.0%; FSR, 28.3%). Conversely, Etest was superior to 30 \u03bcg cefuroxime for categorization of susceptibility to cefuroxime (agreement, 57.1% versus 60.4%; VME, 2.6% versus 9.7%; FSR, 7.1% versus 26.8%). Benzylpenicillin (1 unit) (EUCAST screening disk) and cefuroxime (5 \u03bcg) identified rPBP3 isolates with highest accuracies (95.5% and 92.2%, respectively). In conclusion, disk screening reliably detects rPBP3\n            <jats:named-content content-type=\"genus-species\">H. influenzae<\/jats:named-content>\n            , but false ampicillin susceptibility is frequent with routine methods. We suggest adding a comment recommending high-dose aminopenicillin therapy or the use of other agents for severe infections with screening-positive isolates that are susceptible to aminopenicillins by gradient or disk diffusion.\n          <\/jats:p>","DOI":"10.1128\/jcm.01630-15","type":"journal-article","created":{"date-parts":[[2015,9,10]],"date-time":"2015-09-10T13:50:23Z","timestamp":1441893023000},"page":"3589-3595","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":24,"title":["Haemophilus influenzae with Non-Beta-Lactamase-Mediated Beta-Lactam Resistance: Easy To Find but Hard To Categorize"],"prefix":"10.1128","volume":"53","author":[{"given":"Dagfinn","family":"Skaare","sequence":"first","affiliation":[{"name":"Department of Microbiology, Vestfold Hospital Trust, T\u00f8nsberg, Norway"},{"name":"Department of Medical Biology, Faculty of Health Sciences, University of Troms\u00f8\u2014The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Lia","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Vestfold Hospital Trust, T\u00f8nsberg, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Hannisdal","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Vestfold Hospital Trust, T\u00f8nsberg, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yngvar","family":"Tveten","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Telemark Hospital Trust, Skien, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Matuschek","sequence":"additional","affiliation":[{"name":"Clinical Microbiology, Central Hospital, V\u00e4xj\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar","family":"Kahlmeter","sequence":"additional","affiliation":[{"name":"Clinical Microbiology, Central Hospital, V\u00e4xj\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rn-Erik","family":"Kristiansen","sequence":"additional","affiliation":[{"name":"Department of Medical Biology, Faculty of Health Sciences, University of Troms\u00f8\u2014The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(14)70734-0"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00040-06"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.45.6.1693-1699.2001"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.7.2834-2839.2005"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES2014.19.49.20986"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10156-003-0278-Y"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkr035"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0112711"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2180-14-131"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2010.10.005"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2012.0116"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1974.03230410046026"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.32.11.2846-2850.1994"},{"key":"e_1_3_3_15_2","unstructured":"European Committee on Antimicrobial Susceptibility Testing (EUCAST). 2015. 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CLSI, Wayne, PA."},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1086\/647952"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.45.5.1585-1588.2001"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00190-07"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00214-08"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkq206"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.05397-11"},{"key":"e_1_3_3_23_2","volume-title":"CLSI document M07-A9","author":"Clinical and Laboratory Standards Institute","year":"2012","unstructured":"Clinical and Laboratory Standards Institute. 2012. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard, 9th ed. CLSI document M07-A9. 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