目的 明确临床百日咳鲍特菌分离株红霉素耐药状况及其ptxP1与ptxP3型构成，比较2种基因型菌株导致的百日咳患儿在临床表现方面的差异。 方法 横断面研究。收集2019年1月至2022年12月北京儿童医院及芜湖市第一人民医院采用细菌分离培养确诊的百日咳病例，采用玻片血清凝集试验鉴定疑似百日咳鲍特菌菌落，使用E试验和K－B纸片法检测分离菌株对红霉素的敏感性。通过聚合酶链式反应扩增ptxP基因并测序，确定其基因型。应用t检验、Mann-Whitney U检验、χ2检验及Fisher′s精确概率法进行统计学分析。 结果 共鉴定出百日咳鲍特菌192株，其中红霉素耐药188株(97。9%)。耐药株中，ptxP1型占30。3%(57/188)，ptxP3型占69。7%(131/188)。在<1岁患儿中，ptxP3型感染患儿发作性咳嗽的发生率较ptxP1型更高(57。1%比29。4%，P<0。05)，ptxP3型较ptxP1型感染患儿出现呼吸暂停或窒息(23。8%比17。6%)、咳嗽后呕吐(44。4%比32。4%)、咳嗽末吸气性啸音(72。0%比50。0%)和并发肺炎/支气管炎(85。7%比73。5%)的概率更高，但差异均无统计学意义(均P>0。05)。在≥1岁患儿中，ptxP1型感染患儿的白细胞值高于ptxP3型感染者[13。5(9。9，24。5)×109/L比10。3(7。0，16。4)×109/L，P<0。05]，ptxP1型较ptxP3型感染患儿出现合并其他病原体感染的概率更高(17。4%比4。4%，P>0。05)。 结论 ptxP3型红霉素耐药百日咳鲍特菌已成为百日咳主要的致病型别；ptxP3型红霉素耐药株比ptxP1型红霉素耐药株引起的婴儿百日咳表现更为典型明显，出现重症的可能性更高。 Objective To determine the erythromycin resistance of Bordetella pertussis isolates and their ptxP1 and ptxP3 phenotypic composition and compare clinical manifestations of children with pertussis caused by the two types of strains。 Methods This was a cross-sectional study， the pertussis cases diagnosed using bacterial culture from January 2019 to December 2022 in Beijing Children′s Hospital and the First People′s Hospital of Wuhu were collected。Any suspected Bordetella pertussis colonies were identified by the slide agglutination test。The susceptibility of isolates to erythromycin was detected by the E-test and K-B test。The ptxP gene was amplified by polymerase chain reaction and sequenced to determine its genotype。t-test， Mann-Whitney U-test， Chi-square test and Fisher′s exact test were use to statistical analysis。 Results A total of 192 strains of Bordetella pertussis were identified， including 188 (97。9%) erythromycin-resistant strains。Among the 188 strains， 30。3%(57/188) belonged to the ptxP1 genotype and 69。7%(131/188) belonged to the ptxP3 genotype。In children aged below 1 year old， the incidence of paroxysmal cough caused by infection with the ptxP3 strain was higher than that with the ptxP1 strain (57。1% vs。29。4%， P<0。05)， and children infected with theptxP3 strain were more likely to develop apnea or asphyxia (23。8% vs。17。6%)， post-tussive vomiting (44。4% vs。32。4%)， whooping cough (72。0% vs。50。0%) and pneumonia or bronchitis (85。7% vs。73。5%) compared to those infected with the ptxP1 strain， but the differences were not statistically significant(all P>0。05)。 In children aged 1 year old and above， the white blood cell count of children infected with theptxP1 strain was higher than that of infections with the ptxP3 strain [13。5(9。9， 24。5)×109/L， 10。3 (7。0， 16。4)×109/L， P<0。05]， and children infected with theptxP1 strain were more likely to contract other pathogen infections than those infected with the ptxP3 strain (17。4% vs。4。4%， P>0。05)。 Conclusions ptxP3 erythromycin-resistant Bordetella pertussis has become the main pathogen of pertussis。Infants with pertussis caused by the ptxP3 erythromycin-resistant strain show more significant manifestations and a higher possibility of severe symptoms than those infected with the ptxP1 erythromycin-resistant strain。
A comparative study on the clinical manifestations of children infected with erythromycin-resistantBordetella pertussis ofptxP1 andptxP3 genotypes
Objective To determine the erythromycin resistance of Bordetella pertussis isolates and their ptxP1 and ptxP3 phenotypic composition and compare clinical manifestations of children with pertussis caused by the two types of strains. Methods This was a cross-sectional study, the pertussis cases diagnosed using bacterial culture from January 2019 to December 2022 in Beijing Children′s Hospital and the First People′s Hospital of Wuhu were collected.Any suspected Bordetella pertussis colonies were identified by the slide agglutination test.The susceptibility of isolates to erythromycin was detected by the E-test and K-B test.The ptxP gene was amplified by polymerase chain reaction and sequenced to determine its genotype.t-test, Mann-Whitney U-test, Chi-square test and Fisher′s exact test were use to statistical analysis. Results A total of 192 strains of Bordetella pertussis were identified, including 188 (97.9%) erythromycin-resistant strains.Among the 188 strains, 30.3%(57/188) belonged to the ptxP1 genotype and 69.7%(131/188) belonged to the ptxP3 genotype.In children aged below 1 year old, the incidence of paroxysmal cough caused by infection with the ptxP3 strain was higher than that with the ptxP1 strain (57.1% vs.29.4%, P<0.05), and children infected with theptxP3 strain were more likely to develop apnea or asphyxia (23.8% vs.17.6%), post-tussive vomiting (44.4% vs.32.4%), whooping cough (72.0% vs.50.0%) and pneumonia or bronchitis (85.7% vs.73.5%) compared to those infected with the ptxP1 strain, but the differences were not statistically significant(all P>0.05). In children aged 1 year old and above, the white blood cell count of children infected with theptxP1 strain was higher than that of infections with the ptxP3 strain [13.5(9.9, 24.5)×109/L, 10.3 (7.0, 16.4)×109/L, P<0.05], and children infected with theptxP1 strain were more likely to contract other pathogen infections than those infected with the ptxP3 strain (17.4% vs.4.4%, P>0.05). Conclusions ptxP3 erythromycin-resistant Bordetella pertussis has become the main pathogen of pertussis.Infants with pertussis caused by the ptxP3 erythromycin-resistant strain show more significant manifestations and a higher possibility of severe symptoms than those infected with the ptxP1 erythromycin-resistant strain.
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