In vitro activity and clinical efficacy of macrolides, cefoperazone-sulbactam and piperacillin/piperacillin-tazobactam against Bordetella pertussis and the clinical manifestations in pertussis patients due to these isolates: A single-centre study in Zhejiang Province, China
Introduction
Pertussis, also known as whooping cough, is an acute respiratory tract infection caused by Bordetella pertussis (B. pertussis). Typical pertussis is characterised by severe, long-lasting, spasmodic, paroxysmal coughing after its initial onset in children, and it is particularly serious in neonates and infants [1], [2]. In recent years, the number of pertussis cases has significantly increased, and it is re-emerging as a public health problem, even in regions with high vaccine coverage [3], [4], [5]. However, antibiotics for treating pertussis are extremely limited, and macrolide antibiotics, such as erythromycin and azithromycin, remain the only recommended antibiotics for the treatment and prophylaxis of this disease [6]. Early intervention with sensitive antibiotics is beneficial and associated with a shortened duration of coughing and reduced risk of death in young infants [1]. Usually, macrolide resistance is not a major concern for pertussis [6], [7], although erythromycin resistance in B. pertussis has been described in some countries [8], [9], [10].
Recently, Wang [11] and Yang et al. [12] found that B. pertussis isolates with high levels of macrolide resistance are very common in some parts of China; thus, alternative antibiotics to treat paediatric pertussis caused by macrolide-resistant strains, or patients for whom treatment has failed, is urgently needed. This study sought to assess the in vitro activity and clinical efficacy of non-macrolide antibiotics – such as piperacillin/piperacillin-tazobactam and cefoperazone-sulbactam – against B. pertussis isolates to find effective alternative antibiotics for treatment.
Section snippets
Ethics
The study was approved by the Local Research Ethics Committee of the Children’s Hospital, Zhejiang University School of Medicine (2016-IRB-014), and informed consent was obtained for experimentation. This research was conducted in accordance with the Declaration of Helsinki and national and institutional standards.
Patients
The patients with suspected pertussis and enrolled in the study were those with a cough lasting >2 weeks, or had at least one of the symptoms of paroxysmal cough, whoop, or
Demographic information and clinical features
A total of 948 patients from Zhejiang Province with suspected pertussis and aged from 21 days to 14 years (median age 5 months and 21 days, 61.8% male) were enrolled between January 1 and December 31 2016. A total of 692 (73.0%) were aged <1 year. Nasopharyngeal swabs were positive for B. pertussis and Bordetella parapertussis by culture in 126 (13.3%) and four (0.4%) of all patients, respectively. The patients with positive culture results of B. pertussis were significantly younger than those
Discussion
Pertussis is a notifiable disease, and it is usually clinically diagnosed in China because laboratory methods – such as culture, PCA or ELISA – are not routinely used. The current institute is one of the few hospitals where culture for B. pertussis is available. The pertussis patients were culture confirmed in the present study, and most of the patients were aged <6 months and had not been vaccinated with diphtheria-pertussis-tetanus vaccine; thus, they were at risk of pertussis [6], [15], [16].
Funding
This work was supported by Natural Science Foundation of Zhejiang Povince, China (LGF 18H010001).
Competing interests
The authors have no conflicts of interest to declare.
Ethical approval
This study was approved by the Ethics Committee and the Institutional Board of Privacy and Security at the hospital (2016-IRB-014), and was performed under the institution’s opt-out passive consent policy.
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2021, International Journal of Antimicrobial AgentsCitation Excerpt :MICs for methicillin and cloxacillin were also generally high (0.5 to >128 mg/L) [38,62,126]. Addition of β-lactamase inhibitors such as clavulanic acid, sulbactam and tazobactam did not appreciably change the MICs when added to various β-lactam antibiotics [62,80,97,117,125]. The latter was not surprising given the lack of β-lactamase detection.
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