Haemophilus influenzae Isolated From Men With Acute Urethritis: Its Pathogenic Roles, Responses to Antimicrobial Chemotherapies, and Antimicrobial Susceptibilities.

Abstract

BACKGROUND:

There have been few comprehensive studies on Haemophilus influenza-positive urethritis.

METHODS:

In this retrospective study, we enrolled 68 men with H. influenzae-positive urethritis, including coinfections with Neisseria gonorrhoeae, Chlamydia trachomatis, and/or genital mycoplasmas: 2, 3, 20, and 43 treated with ceftriaxone, levofloxacin, sitafloxacin, and extended-release azithromycin (azithromycin-SR), respectively. We assessed microbiological outcomes in 54 men and clinical outcomes in 46 with H. influenzae-positive monomicrobial nongonococcal urethritis. We determined minimum inhibitory concentrations (MICs) of 6 antimicrobial agents for 59 pretreatment isolates.

RESULTS:

H. influenzae was eradicated from the men treated with ceftriaxone, levofloxacin, or sitafloxacin. The eradication rate with azithromycin-SR was 85.3%. The disappearance or alleviation of urethritis symptoms and the decreases in leukocyte counts in first-voided urine were significantly associated with the eradication of H. influenzae after treatment. For the isolates, ceftriaxone, levofloxacin, sitafloxacin, azithromycin, tetracycline, and doxycycline MICs were ≤0.008-0.25, 0.008-0.5, 0.001-0.008, 0.12-1, 0.25-16, and 0.25-2 μg/mL, respectively. The azithromycin MICs for 3 of 4 strains persisting after azithromycin-SR administration were 1 μg/mL. H. influenzae with an azithromycin MIC of 1 μg/mL increased chronologically.

CONCLUSIONS:

H. influenzae showed good responses to the chemotherapies for urethritis. The significant associations of the clinical outcomes of the chemotherapies with their microbiological outcomes suggested that H. influenzae could play pathogenic roles in urethritis. All isolates, except for one with decreased susceptibility to tetracyclines, were susceptible to the examined agents. However, the increase in H. influenzae with an azithromycin MIC of 1 μg/mL might threaten efficacies of azithromycin regimens on H. influenzae-positive urethritis.

• Authors: Shin Ito, Kyoko Hatazaki, Ken Shimuta, Hiromi Kondo, Kosuke Mizutani, Mitsuru Yasuda, Keita Nakane, Tomohiro Tsuchiya, Shigeaki Yokoi, Masahiro Nakano, Makoto Ohinishi, Takashi Deguchi
• Journal: Sexually transmitted diseases (Sex Transm Dis) Vol. 44 Issue 4 Pg. 205-210 (04 2017) ISSN: 1537-4521 [Electronic] United States
• PMID: 28282645 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Fluoroquinolones
• Levofloxacin
• Ceftriaxone
• Azithromycin
• sitafloxacin
• Doxycycline

Topics

• Acute Disease
• Anti-Bacterial Agents (pharmacology)
• Azithromycin (pharmacology)
• Ceftriaxone (pharmacology)
• Chlamydia Infections (drug therapy, microbiology)
• Chlamydia trachomatis
• Coinfection (drug therapy)
• Doxycycline (pharmacology)
• Drug Resistance, Bacterial (drug effects)
• Fluoroquinolones (pharmacology)
• Gonorrhea (drug therapy, microbiology)
• Haemophilus influenzae (drug effects, isolation & purification)
• Humans
• Leukocyte Count (methods)
• Levofloxacin (pharmacology)
• Male
• Microbial Sensitivity Tests
• Neisseria gonorrhoeae
• Retrospective Studies
• Urethritis (drug therapy, microbiology, urine)