成人百日咳鲍德特菌感染的临床特点及菌株体外耐药性分析  

Drug-resistance of Bordetella pertussis isolated from adults and clinical characteristics of pertussis in adults

作　　者：马富艳 华春珍[1] 谢永平[1] 汪洪姣[1] 李建平[1] 袁天明[1] Ma Fu-yan;Hua Chun-zhen;Xie Yong-ping;Wang Hong-jiao;Li Jian-ping;Yuan Tian-ming(The Children's Hospital Zhejiang University School of Medicine,Hangzhou 310003;Department of Pediatrics,the No.1 People’s Hospital of Pinghu,Pinghu 314200)

机构地区：[1]浙江大学医学院附属儿童医院,杭州310003 [2]平湖市第一人民医院,平湖314200

出　　处：《中国抗生素杂志》2021年第9期879-883,共5页Chinese Journal of Antibiotics

基　　金：浙江省基础公益研究计划项目(No.LGF18H010001)。

摘　　要：目的了解成人百日咳鲍德特菌感染的临床特点及其菌株的体外耐药性,为儿童本病的防治提供参考。方法对2016年1月至2018年12月经细菌培养证实的成人感染者(我院百日咳疑诊患儿的家长)进行临床特点分析。百日咳鲍德特菌以百日咳血清凝集试验鉴定并经质谱分析验证。药敏试验采用E-test法。结果研究年限内疑诊为百日咳的74名住院患儿的209名家属进行百日咳鲍德特菌培养,86(41.1%)人阳性,女性占81.4%(70/86),年龄范围24~70岁,平均(36.1±11.9)岁。65.1%(56/86)为患儿母亲,18.6%(16/86)为父亲,15.1%(13/86)为祖父母、外祖父母。86.0%(74/86)标本采集前未使用过抗菌药物,70.3%(52/74)的家庭有2名或2名以上儿童。仅37例(43.0%)的感染者有咳嗽症状,其中9例(10.5%,9/86)咳嗽剧烈;49例(57.0%,49/86)无明显咳嗽症状。这些成人家庭的74名住院儿童中40.5%(30/74)百日咳培养阴性。菌株对红霉素、阿奇霉素和克林霉素的MIC_(50)和MIC_(90)均>256μg/mL,57.0%的菌株为MIC>256μg/mL的高水平耐药株。对头孢曲松、头孢哌酮舒巴坦、头孢他啶、复方磺胺甲恶唑和美罗培南的MIC_(90)分别为0.19、0.064、0.19、0.5和0.125μg/mL。所有菌株对哌拉西林的MIC均<0.016μg/mL。分别用阿奇霉素和复方磺胺甲恶唑治疗患者,2周时鼻咽部细菌的清除率分别达86.8%和76.9%。结论百日咳鲍德特菌对大环内酯类耐药率高,成人口服复方磺胺甲恶唑能有效清除鼻咽部大环内酯类耐药株;对所有家庭成员进行百日咳鲍德特菌检测有助于提高儿童百日咳的病原诊断率。Objective To know the antibiotics-resistance of Bordetella pertussis isolated from adults and the clinical characteristic of pertussis in adults,which will provide references for diagnosis and prevention of pertussis in children.Methods Clinical data from adults(pediatric inpatients'family members)confirmed with Bordetella pertussis infections based on cultures were collected between January 2016 and December 2018.Bordetella pertussis was identified with pertussis antiserum and mass spectrometry.The E-test method was used for drug susceptibility test.Results Eighty-six adult family members of the 74 pediatric inpatients with suspected pertussis were confirmed with Bordetella pertussis infections based on cultures and the positive rate was 41.1%.They aged from 24 to 70 years old[(36.1±11.9)years]and 81.4%(70/86)of which were female.Fifty-six(65.1%,56/86)were mothers,18.6%(16/86)were fathers and 15.1%(13/86)were grandparents.Seventy-four(86.0%)did not have previous antibiotics when samples were collected,and 70.3%(52)of the 74 families had 2 or more than 2 children.Thirty-seven(43.0%)had cough and the symptoms were severe in nine patients(10.5%),while 57.0%(49/86)were asymptomatic.Thirty(40.5%)of the 74 children with suspected pertussis had negative results in Bordetella pertussis cultures.The MIC_(50)and MIC_(90)of erythromycin,azithromycin,and clindamycin in 86 strains were all>256μg/mL and 57.0%were highly resistant strains with MIC>256μg/mL.MIC_(90)of ceftriaxone,cefoperazone-sulbactam,ceftazidime,sulfamethoxazoletrimethoprim,and meropenem were 0.19,0.064,0.19,0.5,and 0.125μg/mL,respectively.MIC of piperacillin in all strains was<0.016μg/mL.Oral azithromycin or oral sulfamethoxazole-trimethoprim were prescribed for different adults,and they cleared the nasopharyngeal bacteria in 86.8%and 76.9%of all infected adults,respectively.Conclusion Resistance to macrolide antibiotics is high in Bordetella pertussis strains in vitro.Treatment with oral sulfamethoxazole-trimethoprim is effective in clearing the nasoph

关 键 词：百日咳鲍德特菌 成人 感染 耐药 最低抑菌浓度 

分 类 号：R978[医药卫生—药品]