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Background  Fluoroquinolone-resistant  Haemophilus influenzae  (FRHI) has been reported worldwide but remain unclear in China.    Methods  A total of 402  H. influenzae  isolates collected from 2016 to 2017 were included. Antimicrobial susceptibility on 10 antibiotics was performed, and minimum inhibitory concentration of ciprofloxacin- and nalidixic acid-resistant strains were further determined by E-test strips, with risk factors also evaluated. Strains with resistance or reduced susceptibility to ciprofloxacin were subjected to sequencing of the quinolone resistance-determining regions (QRDR) and plasmid-mediated quinolone resistance genes by sequencing, with multi-locus sequence typing.    Results  2.2% of  H. influenzae  strains were non-susceptible (7/402, 1.7%) or susceptible (2/402, 0.5%) to ciprofloxacin but NAL-resistant by E-test, and multidrug resistance was more common in fluoroquinolones non-susceptible  H. influenzae  group ( p  = 0.000). Infection risk factors included invasive procedure ( p  = 0.011), catching cold/previous contact with someone who had a cold ( p  = 0.019), fluoroquinolones use during previous 3 months ( p  = 0.003). With none of mutations obtained in  gyrB ,  parE  and other plasmid-mediated quinolone resistance genes, 7 and 4 strains were found for Ser-84-Leu substitutions in  gyrA  and one amino acid substitution in the QRDR of  gyrA  linked with one amino acid substitution in the QRDR of  parC , respectively. In addition, five sequence types (ST) were identified, with ST1719 firstly found.    Conclusions  For the first time, this study has reported the incidence, risk factors, molecular determinants on fluoroquinolones resistance and ST of FRHI strains in mainland China, representing the first evidence of mutation of gyrA and parC in China and the new ST1719 worldwide.

Microbial virulence, molecular epidemiology and pathogenic factors of fluoroquinolone-resistant Haemophilus influenzae infections in Guangzhou, China