Li Li-Jun, Liu Ying, Jia Ju, Yuan Lin, Shi Wei, Meng Qing-Hong, Yao Kai-Hu
National Center for Children's Health/Beijing Children's Hospital, Capital Medical University/Beijing Pediatric Research Institute/National Key Discipline of Pediatrics (Capital Medical University)/National Clinical Research Center for Respiratory Diseases/Key Laboratory of Major Diseases in Children, Ministry of Education/Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing 100045, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2019 Mar;21(3):208-213. doi: 10.7499/j.issn.1008-8830.2019.03.004.
To investigate the alternative antimicrobial drugs for the treatment of neonatal pertussis and the antigen genotypes of Bordetella pertussis (B. pertussis) strains.
A total of 32 B. pertussis strains isolated from neonates between May 2013 and July 2018 were used in this study. E-test stripes were used to measure the minimal inhibitory concentration (MIC) of 18 antimicrobial drugs including erythromycin, sulfamethoxazole-trimethoprim (SMZ) and ampicillin. The 23S rRNA gene of isolated strains was amplified and sequenced to identify the mutation site of erythromycin resistance gene, and the seven antigen genotypes of B. pertussis strains (ptxA, ptxC, ptxP, prn, fim2, fim3 and tcfA2) were analyzed.
Of the 32 B. pertussis strains, 25 (78%) were resistant to erythromycin, azithromycin, clarithromycin and clindamycin, with an MIC of >256 mg/L, and A2047G mutation was observed in the 23S rRNA gene. All strains had an MIC of ≤0.064 mg/L for SMZ. The MIC of ampicillin, amoxicillin, amoxicillin-clavulanic acid and ceftriaxone ranged from 0.032 to 1 mg/L. The strains resistant to macrolide antibiotics had an antigen genotype of ptxA1/ptxC1/ptxP1/prn1/fim2-1/fim3-1/tcfA2.
B. pertussis strains from neonates are often resistant to macrolides, and the in vitro test shows that off-label use of sulfonamides is a reliable regimen for the treatment of neonates with macrolide-resistant pertussis. The prevalence of drug-resistant strains further emphasizes the importance of immunoprophylaxis.
探讨治疗新生儿百日咳的替代抗菌药物及百日咳博德特氏菌（百日咳杆菌）菌株的抗原基因型。
本研究使用了2013年5月至2018年7月间从新生儿中分离出的32株百日咳杆菌菌株。采用E-test试纸条测定包括红霉素、磺胺甲恶唑-甲氧苄啶（SMZ）和氨苄西林在内的18种抗菌药物的最低抑菌浓度（MIC）。对分离菌株的23S rRNA基因进行扩增和测序，以鉴定红霉素耐药基因的突变位点，并分析百日咳杆菌菌株的七种抗原基因型（ptxA、ptxC、ptxP、prn、fim2、fim3和tcfA2）。
32株百日咳杆菌菌株中，25株（78%）对红霉素、阿奇霉素、克拉霉素和克林霉素耐药，MIC>256mg/L，23S rRNA基因中观察到A2047G突变。所有菌株对SMZ的MIC≤0.064mg/L。氨苄西林、阿莫西林、阿莫西林-克拉维酸和头孢曲松的MIC范围为0.032至1mg/L。对大环内酯类抗生素耐药的菌株具有ptxA1/ptxC1/ptxP1/prn1/fim2-1/fim3-1/tcfA2的抗原基因型。
新生儿百日咳杆菌菌株常对大环内酯类耐药，体外试验表明，磺胺类药物的非标签使用是治疗大环内酯类耐药百日咳新生儿的可靠方案。耐药菌株的流行进一步强调了免疫预防的重要性。
