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Background:  The serotype and antimicrobial resistance of  Haemophilus influenzae  in adult patients have changed due to the application of antimicrobials and  H. influenzae  type b (Hib) vaccine worldwide. However, the epidemiologic characteristics of  H. influenzae  in Shanghai are still unavailable.   Objective:  To determine the serotype distribution, antimicrobial resistance and multilocus sequence type (MLST) of  H. influenzae  in adult patients in Shanghai.   Methods:  A total of 51 clinical isolates from adult patients were consecutively collected. Serotypes were determined according to specific capsule gene,  bexA , amplified by PCR. Antimicrobial susceptibility test was carried out by the broth microdilution method. β-lactamase production was detected by cefinase disk and the  ftsI  gene were amplified and sequenced to determine the penicillin binding protein 3 (PBP3) mutation. Molecular epidemiology was performed by MLST analyses.   Results:  All isolates studied were nontypeable  H. influenzae  (NTHi) and three of them (5.88%) caused invasive infection. The resistant rates of ampicillin and trimethoprim/sulfamethoxazole were both 45.10%. One third of these isolates produced TEM-1 type β-lactamase and 11.76% were β-lactamase negative ampicillin resistant strains (BLNAR). The PBP3 mutation was detected in 74.51% of the isolates, of which 12 belonged to group III. A total of 36 sequence types (STs) were identified among all isolates. Four isolates of ST103 (7.84%) all produced β-lactamase without mutation of PBP3.   Conclusion:   H. influenzae  infections among adults in Shanghai are predominately caused by NTHi with genetic diversity among adult patients. The prevalence of both β-lactamase production and PBP3 mutation may contribute to high ampicillin resistance rate in Shanghai.

Molecular Epidemiology and Antimicrobial Resistance of Haemophilus influenzae in Adult Patients in Shanghai, China