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As a threat to treatment, resistance against critically important antibiotics is on the rise in\n            <jats:named-content content-type=\"genus-species\">H. influenzae<\/jats:named-content>\n            . Identifying mechanisms for horizontal acquisition of resistance genes is important to understand how multidrug resistance develops. The present study explores the antimicrobial resistance genes and their context in beta-lactam-resistant\n            <jats:named-content content-type=\"genus-species\">H. influenzae<\/jats:named-content>\n            with coresistance to up to four non-beta-lactam groups. The results reveal that this organism is capable of acquiring resistance to a wide range of commonly used antibiotics through conjugative transfer of mobile genetic elements and transformation of chromosomal genes, resulting in mosaic genes with a broader resistance spectrum. Strains with chromosomally mediated resistance to extended-spectrum cephalosporins, co-trimoxazole, and quinolones combined with mobile genetic elements carrying genes mediating resistance to ampicillin, tetracyclines, and chloramphenicol have been reported, and further dissemination of such strains represents a particular concern.\n          <\/jats:p>","DOI":"10.1128\/msphere.00969-19","type":"journal-article","created":{"date-parts":[[2020,1,28]],"date-time":"2020-01-28T09:40:07Z","timestamp":1580204407000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":41,"title":["Role of Horizontal Gene Transfer in the Development of Multidrug Resistance in Haemophilus influenzae"],"prefix":"10.1128","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1314-0497","authenticated-orcid":false,"given":"Kristin","family":"Hegstad","sequence":"first","affiliation":[{"name":"Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North-Norway, Troms\u00f8, Norway"},{"name":"Research Group for Host-Microbe Interactions, Department of Medical Biology, Faculty of Health Sciences, University of Troms\u00f8 (UiT)\u2014The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haima","family":"Mylvaganam","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Haukeland University Hospital, Bergen, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9991-6315","authenticated-orcid":false,"given":"Jessin","family":"Janice","sequence":"additional","affiliation":[{"name":"Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North-Norway, Troms\u00f8, Norway"},{"name":"Research Group for Host-Microbe Interactions, Department of Medical Biology, Faculty of Health Sciences, University of Troms\u00f8 (UiT)\u2014The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen","family":"Josefsen","sequence":"additional","affiliation":[{"name":"Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North-Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audun","family":"Sivertsen","sequence":"additional","affiliation":[{"name":"Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North-Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dagfinn","family":"Skaare","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Vestfold Hospital Trust, T\u00f8nsberg, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(14)70734-0"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00040-06"},{"key":"e_1_3_2_4_2","unstructured":"WHO Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR). 2019. 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