Clinical characteristics and macrolide resistance analysis of pertussis in children: a retrospective study.

PURPOSE: Pertussis is mainly caused by Bordetella pertussis. Currently, no reports exist on the incidence of B. pertussis infection or on its patterns of macrolide resistance among pediatric cases in Xiamen, Fujian Province, China. The aim of this study was to determine the clinical characteristics and macrolide resistance patterns in pediatric pertussis.

METHODS

We retrospectively collected data from 968 children with pertussis between February 2021 and January 2025. Demographic characteristics, disease trends, clinical features, and macrolide resistance among outpatients and inpatients were analyzed.

RESULTS

Most inpatients with pertussis were infants aged < 3 months, whereas most outpatients were school-aged children. Inpatients demonstrated significantly higher rates of leukocytosis, fever, co-infection, recent exposure to individuals with a cough, comorbid pneumonia, and macrolide use and experienced longer time from cough onset to confirmed diagnosis than did outpatients. The proportion of children who presented with spasmodic cough, violent coughing with facial flushing, inspiratory whoop, tachypnea, cyanosis, hypoxemia, and respiratory failure, as well as the average hospital stay, was significantly higher among children with severe pertussis than among those with common pertussis. Age younger than 3 months, being unvaccinated, co-infection, leukocytosis, lymphocytosis, spasmodic cough, facial flushing, inspiratory whoop, tachypnea, and cyanosis were risk factors for severe pertussis. Macrolides were the main antibiotics prescribed for children with pertussis. The detection rate of drug-resistant mutation sites was 77.52% in outpatients and 92.50% in inpatients.

CONCLUSION

It is necessary to enhance the vaccination of pertussis for special populations, including women in the later pregnancy stages and school-aged children. Children with pertussis who have risk factors should be monitored to identify severe cases. The empirical use of macrolides for pertussis treatment is effective in most cases; alternative agents should be considered if the response is suboptimal, especially when drug-resistant mutation sites are identified.