Mendelman P M, Doroshow C A, Gandy S L, Syriopoulou V, Weigen C P, Smith A L
J Infect Dis. 1984 Jul;150(1):30-9. doi: 10.1093/infdis/150.1.30.
The increasing prevalence of infections due to ampicillin-resistant strains of Haemophilus influenzae type b requires that suspected H. influenzae meningitis in children be initially treated with both ampicillin and chloramphenicol. Previously, the recognition of strains resistant to chloramphenicol but susceptible to ampicillin supported combination chemotherapy. In this study one case of meningitis due to a strain of H. influenzae resistant to ampicillin, chloramphenicol, and tetracycline was analyzed. The patient involved received intravenous trimethoprim-sulfamethoxazole, but putative resistance to this combination prompted the additional administration of intravenous moxalactam. The resistance of this organism was mediated by a conjugative 43-megadalton R plasmid; the determinants of ampicillin and chloramphenicol resistance were transferred as a single unit. However, not all of the multiply resistant transconjugants contained a detectable plasmid; DNA homology studies with R plasmids of H. influenzae confirmed that these extrachromosomal DNA sequences were associated with chromosomal DNA and that an extrachromosomal location was rare.
b型流感嗜血杆菌氨苄西林耐药菌株引起的感染日益普遍，这就要求对疑似儿童流感嗜血杆菌脑膜炎患者，最初应同时使用氨苄西林和氯霉素进行治疗。以前，认识到对氯霉素耐药但对氨苄西林敏感的菌株支持联合化疗。在本研究中，分析了1例由对氨苄西林、氯霉素和四环素均耐药的流感嗜血杆菌菌株引起的脑膜炎病例。该患者接受了静脉注射甲氧苄啶-磺胺甲恶唑治疗，但对该联合用药存在假定耐药性，促使额外给予静脉注射莫西沙星。该菌株的耐药性由一个接合性43兆道尔顿R质粒介导；氨苄西林和氯霉素耐药决定簇作为一个单一单元转移。然而，并非所有多重耐药的接合子都含有可检测到的质粒；对流感嗜血杆菌R质粒进行的DNA同源性研究证实，这些染色体外DNA序列与染色体DNA相关，且染色体外定位很少见。
