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Microbiology reference laboratories perform a crucial role within public health systems. This role was especially evident during the COVID-19 pandemic. In this Viewpoint, we emphasise the importance of microbiology reference laboratories and highlight the types of digital data and expertise they provide, which benefit national and international public health. We also highlight the value of surveillance initiatives among collaborative international partners, who work together to share, analyse, and interpret data, and then disseminate their findings in a timely manner. Microbiology reference laboratories have substantial impact at regional, national, and international levels, and sustained support for these laboratories is essential for public health in both pandemic and non-pandemic times., Competing Interests: Declaration of interests EV has received research grants from the French Public Health Agency, Pfizer, and MSD (paid to Centre Hospitalier Intercommunal de Créteil). SD has received a research grant from Pfizer; and advisory board and speaker fees from Merck-MSD (paid to University Hospitals Leuven). MH and CC have received funding from the Federal Office of Public Health (paid to The Swiss National Reference Center for Invasive Pneumococci). MH has participated on a data safety monitoring board or advisory board for both Pfizer and MSD. MH also holds investigator-initiated grants from Pfizer and MSD paid to his institution. However, the sponsors had no role in the data analysis and content of this manuscript. AS and AKu have received funding from the National Science Centre, MSD, and Pfizer; and equipment from The Great Orchestra of Christmas Charity Foundation and the Clinical Microbiology Center Foundation (paid and sent to The National Medicines Institute, Warsaw). AKu has received payments from Sandoz, and Pfizer for lectures. AS has received payments from MSD and Pfizer for lectures; and from MSD, Pfizer, and Sanofi Pasteur for participation on advisory boards. LL and MT have received research funding from Pfizer (paid to The Finnish Institute for Health and Welfare). ABB has received funding from MSD for IRIS pneumococcal genome sequencing. ABB is an unpaid advisor to WHO, providing expertise related to vaccines and antimicrobial resistance. ABB is also an unpaid General Assembly member (from 2022 onwards); and was a board member from 2016 to 2022, and Secretary from 2018 to 2022 for the International Society of Pneumonia and Pneumococcal Diseases. MD has received financial support from Pfizer to attend national scientific meetings. HH has received a grant from Pfizer to investigate Irish pneumococcal serotypes with whole genome sequencing. HH has received consulting fees from Bons Secours Hospital Group (Ireland). HH has received payment from the Scottish Hospitals Enquiry for expert testimony. KAJ has received personal royalties from GSK; and personal honoraria from the Wellcome Trust. T-TL has received consulting fees from the Trond Mohn Foundation. T-TL is an unpaid board member for the European Society for Meningococcal and Haemophilus influenzae disease, and the German Society for Hygiene and Microbiology (committee for microbial systematics, population genetics and infection epidemiology). H-CS has received funding from Pfizer for a pneumococcal carriage project. H-CS has received funding for consultations on a data safety monitoring board or advisory board for MSD. MPGvdL has received research funding from Pfizer and Merck (paid to the Reference Laboratory for Streptococci in Aachen, Germany); has received consulting fees from Pfizer, Merck, and GSK; payment or honoraria from Pfizer and Merck; and support for attending meetings or travel from Pfizer. AvG is the chairperson for the National Immunization Technical Advisory Group (National Advisory Group on Immunization) for South Africa. NMvS has received fees for services and consulting fees from MSD and GSK; consulting fees from Pfizer; and research funding from the Dutch Health Counsel, Argenx, Leducq Foundation, and Amsterdam UMC (all paid to their institution). NMvS holds a patent (WO 2013/020090 A3) on vaccine development against Streptococcus pyogenes. NMvS is an unpaid scientific advisor to the ItsME foundation, and a scientific advisor to Rapua te me ngaro ka tau (fees are paid to the University of Amsterdam). NMvS holds personal stock in Genmab and the Bank of America. JY has received payments for lectures given at scientific meetings organised by MSD and Pfizer; has received support from MSD and Pfizer to attend national and international scientific meetings; and has participated on MSD and Pfizer advisory boards. JS has participated on advisory boards for MSD. HC has received payment from Sanofi-Aventis Germany for a lecture; and is an unpaid external advisor to the German Standing Committee on Vaccination. SM is an unpaid external expert for an advisory board for enquiry into the landscape for a MenB vaccine in South Africa. JVM performs contract work for the Institute of Health Carlos III funded by GSK and Pfizer; and receives consulting fees from Pfizer and Sanofi Pasteur. MC has received an Investigator Initiated Research grant from Pfizer (W1243730; paid to their institution, Children's Health Ireland). MC is part of a working group for The National Immunisation Advisory Committee in Ireland. KGK has received funding from the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) to attend the ESCMID global meeting in Barcelona as a member of the Professional Affairs Subcommittee. CM-A has received payments for invited lectures given at scientific meetings for MSD, Sanofi-Pasteur, and Pfizer. CM-A has received support from MSD and Pfizer to attend national and international scientific meetings. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Haemophilus influenzae (Hi) is known as a cause of invasive and non-invasive diseases. Especially ear, nose and throat (ENT) infections are common reasons for antibiotic prescriptions in outpatient settings in Germany. Therefore, antibiotic resistance surveillance is important to provide the basis of recommendations for the empirical usage of antibiotic agents., Objectives: To provide data on susceptibility rates of oral antibiotics for non-invasive clinical Hi isolates in Germany and to investigate molecular resistance patterns of β-lactams, ciprofloxacin, doxycycline and trimethoprim/sulfamethoxazole., Methods: Isolates were collected from a sentinel network of diagnostic laboratories in a prospective multicentre prevalence study. Antibiotic susceptibility testing was done with a commercial broth microdilution kit. MICs were interpreted according to EUCAST guidelines. Resistance gene sequencing and WGS were performed to analyze molecular antibiotic resistance patterns and genetic relationships between the isolates., Results: In total, 215 Hi isolates were collected from 23 laboratories across Germany. The highest resistance rates were found for amoxicillin ( n  = 30; 14%), cefuroxime ( n  = 40; 18.6%) and trimethoprim/sulfamethoxazole (co-trimoxazole) ( n  = 34; 15.8%). Resistance to amoxicillin was mainly due to bla TEM-1 ( n  = 29; 96.7%). PBP3 alterations were found in 39 of 40 cefuroxime-resistant isolates (97.5%). Two of the cefuroxime-resistant isolates harboured PBP3 mutation patterns that have not yet been associated with cefuroxime resistance; in one of them, a known lpoA mutation was found. One isolate showed no mutations in PBP3 or lpoA. All co-trimoxazole-resistant isolates (15.8%) showed known mutations in folA and its promoter region. Additionally, point mutations in folP were identified in a subset of these isolates. The most frequent sequence types (STs) were ST57 ( n  = 10) and ST103 ( n  = 10). Genetic cluster analysis identified six clusters, but no epidemiological link could be confirmed., Conclusion: Resistance to oral antibiotics in non-invasive clinical Hi isolates in Germany was generally low. Amoxicillin is estimated to cover 86% of infections involving non-invasive Hi and, therefore, is still effective for the first-line empirical treatment for ENT infections in Germany. Further surveillance of antimicrobial susceptibility in non-invasive Hi isolates is important to ensure the data basis for guidelines of antibiotic usage., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)