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The aim of this study was to clarify the clarithromycin resistance mechanisms of β-lactamase-nonproducing ampicillin-resistantHaemophilus influenzae strains. In all clarithromycin-resistant strains, the transcript level ofacrB was significantly elevated, and these strains had a frameshift mutation inacrR . Introduction of theacrR mutation intoH. influenzae Rd generated a clarithromycin-resistant transformant with the same MIC as the donor strain. Our results indicate that theacrR mutation confers clarithromycin resistance by the increasing the transcription ofacrB .

Clarithromycin Resistance Mechanisms of Epidemic β-Lactamase-Nonproducing Ampicillin-Resistant Haemophilus influenzae Strains in Japan