International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Characteristics, clinical manifestations, and severe disease risk of Bordetella pertussis infection in children: a tNGS-based retrospective study.
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Zhao Jiangyang, Mo Lishai, Chen Xiaoying, Lu Junming, Chen Jielin, Liu Guangbing, Lu Cuihong, Hu Xuehua, Huang Qiang, Tang Wenting, Tan Jie, Fu Chunyun
Аннотация
OBJECTIVES: Given the global resurgence of pertussis, this study aimed to systematically investigate the epidemiology, clinical features, and risk factors for severe illness of Bordetella pertussis infection among hospitalized children with acute respiratory infections in Guangxi, China, from 2021 to 2024.
METHODS: This retrospective study enrolled 10,153 children hospitalized with acute respiratory infections at a tertiary hospital in Guangxi, China (April 2021-December 2024). Clinical data were collected, and targeted next-generation sequencing (tNGS) was performed on respiratory specimens for pathogen identification. Multivariate logistic regression was utilized to identify independent risk factors for severe illness requiring intensive care unit (ICU) admission.
RESULTS: B. pertussis was detected in 3.4% (342/10,153) of children ≤ 14 years, mostly in infants <1 year (43.6%, 149/342). Co-detection with other respiratory microbes was observed in 94.7% of positive cases. Although rare (5.3%), B. pertussis mono-detection was significantly associated with younger age, higher bacterial load, and more severe clinical outcomes versus co-detection. Specifically, the mono-detection group had significantly higher intensive care unit (ICU) admission rates (22.2% vs 5.9%, P = 0.027) and longer hospital stays (9 vs 6 days, P = 0.017). Key independent risk factors for ICU admission included younger age, prolonged fever, atelectasis, and co-detection of B. pertussis with enterovirus. Macrolide resistance genes were found in 51.5% of B. pertussis strains.
CONCLUSION: B. pertussis actively circulates among children in Guangxi, China. Sole B. pertussis detection was associated with more severe clinical presentations. Younger age, prolonged fever, atelectasis, and enterovirus co-detection were major drivers of severe disease, underscoring the need for early recognition and intervention.
METHODS: This retrospective study enrolled 10,153 children hospitalized with acute respiratory infections at a tertiary hospital in Guangxi, China (April 2021-December 2024). Clinical data were collected, and targeted next-generation sequencing (tNGS) was performed on respiratory specimens for pathogen identification. Multivariate logistic regression was utilized to identify independent risk factors for severe illness requiring intensive care unit (ICU) admission.
RESULTS: B. pertussis was detected in 3.4% (342/10,153) of children ≤ 14 years, mostly in infants <1 year (43.6%, 149/342). Co-detection with other respiratory microbes was observed in 94.7% of positive cases. Although rare (5.3%), B. pertussis mono-detection was significantly associated with younger age, higher bacterial load, and more severe clinical outcomes versus co-detection. Specifically, the mono-detection group had significantly higher intensive care unit (ICU) admission rates (22.2% vs 5.9%, P = 0.027) and longer hospital stays (9 vs 6 days, P = 0.017). Key independent risk factors for ICU admission included younger age, prolonged fever, atelectasis, and co-detection of B. pertussis with enterovirus. Macrolide resistance genes were found in 51.5% of B. pertussis strains.
CONCLUSION: B. pertussis actively circulates among children in Guangxi, China. Sole B. pertussis detection was associated with more severe clinical presentations. Younger age, prolonged fever, atelectasis, and enterovirus co-detection were major drivers of severe disease, underscoring the need for early recognition and intervention.