ROC curve of frequency of LP by average rainfall.

<p>ROC curve of frequency of LP by average rainfall.</p

Monthly distribution of LP group and non-LP group patients.

<p>Monthly distribution of LP group and non-LP group patients.</p

Cases of sporadic LP admitted to our hospital from 1995 through 2011.

<p>Cases that occurred during each monthly reporting period are shown in the line graph, while average rainfall is shown in the bar graph.</p

Molecular Epidemiology of Nontypeable <i>Haemophilus influenzae</i> Causing Community-Acquired Pneumonia in Adults

<div><p>Nontypeable <i>Haemophilus influenzae</i> (NTHi) is an opportunistic pathogen which causes a variety of respiratory infections. The objectives of the study were to determine its antimicrobial susceptibility, to characterize the β-lactam resistance, and to establish a genetic characterization of NTHi isolates. Ninety-five NTHi isolates were analyzed by pulsed field gel electrophoresis (PFGE) and multi locus sequence typing (MLST). Antimicrobial susceptibility was determined by microdilution, and the <i>fts</i>I gene (encoding penicillin-binding protein 3, PBP3) was PCR amplified and sequenced. Thirty (31.6%) isolates were non-susceptible to ampicillin (MIC≥2 mg/L), with 10 of them producing β-lactamase type TEM-1 as a resistance mechanism. After <i>fts</i>I sequencing, 39 (41.1%) isolates showed amino acid substitutions in PBP3, with Asn526→ Lys being the most common (69.2%). Eighty-four patients were successfully treated with amoxicillin/clavulanic acid, ceftriaxone and levofloxacin. Eight patients died due either to aspiration or complication of their comorbidities. In conclusion, NTHi causing CAP in adults shows high genetic diversity and is associated with a high rate of reduced susceptibility to ampicillin due to alterations in PBP3. The analysis of treatment and outcomes demonstrated that NTHi strains with mutations in the <i>fts</i>I gene could be successfully treated with ceftriaxone or fluoroquinolones.</p></div

Amino acid substitutions in the transpeptidase domain of PBP3 identified in 95 NTHi isolates.

<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0082515#pone.0082515-Dabernat1" target="_blank">[24]</a>; the miscellaneous group was classified according to the criteria of García-Cobos et al. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0082515#pone.0082515-GarciaCobos1" target="_blank">[10]</a> and the data from this study.^a The isolates were classified into groups I, IIa, IIb and IIc, according to the criteria of Dabernat et al. </p><p>≤1 mg/L; AMC Resistant: ≥8/4 mg/L; AMC susceptible: ≤4/2 mg/L;^b AMP Resistant: >4 mg/L; AMP Intermediate: 2 mg/L; AMP Susceptible </p><p>+: positive; -: negative);^c BL: Beta-lactamase production (</p><p> = 3), ST36, ST98, ST103, ST139 (n = 2), ST145 (n = 3), ST159 (n = 3), ST183, ST203 (n = 3), ST241 (n = 2), ST245, ST266, ST270, ST272, ST385, ST408, ST414 (n = 2), ST519 (n = 4), ST582, ST679, ST714, ST974, ST989, ST990, ST992, ST995, ST1174, ST1176, ST1178, ST1179, ST1180, ST1181, ST1182, ST1183 and ST1184.^d ST11 (n</p

Tree diagram showing the genetic relatedness of 39 nontypeable <i>H. influenzae</i> isolates with mutations in the <i>fts</i>I gene (gBLNAR n = 36 and gBLPACR n = 3) obtained by PFGE according to Dice's similarity index.

<p>Dice coefficients are shown above the tree diagram. Isolates with ≥80% relatedness are considered highly genetically related.</p

Minimal inhibitory concentrations (MIC) of 10 antimicrobials. MIC against 95 NTHi isolates using the microdilution method according to CLSI breakpoints.

<p>^a CLSI: Clinical and Laboratory Standards Institute. I: intermediate; R: resistant.</p><p>∶1.^b The ratio of amoxicillin/clavulanic acid was 2</p><p>∶19.^c The ratio of cotrimoxazole was 1</p

Factors associated with mortality in patients with COPD and pneumonia: multivariate analysis.

<p>COPD, chronic obstructive pulmonary disease; OR: odds ratio; PSI, pneumonia severity index.</p><p>Factors associated with mortality in patients with COPD and pneumonia: multivariate analysis.</p

Characteristics of pneumonia by study group.

<p>COPD, chronic obstructive pulmonary disease; IQR, interquartile range; PSI, pneumonia severity index.</p>1<p>Data available only for 1396 patients.²Data available from January 2001, only for 3084 patients; ³Data available from January 2001, only for 3084 patients⁴Patients were stratified into the following risk classes according to the PSI score: low risk (≤90 points, classes I, II, and III) and high risk (>90 points, classes IV and V).</p><p>Characteristics of pneumonia by study group.</p

Etiology of pneumonia by study group.

<p>COPD, chronic obstructive pulmonary disease; 72 (7.3%) patients with COPD and 118 (3.7%) patients without COPD had more than one cause of community-acquired pneumonia.</p><p>Etiology of pneumonia by study group.</p