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Infect."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Since the first report of erythromycin-resistant\n                    <jats:italic>Bordetella pertussis<\/jats:italic>\n                    (\n                    <jats:italic>B. pertussis<\/jats:italic>\n                    ) in Arizona in 1994, macrolide-resistant strains have emerged worldwide, threatening pertussis control. This systematic review and meta-analysis aimed to quantify the prevalence and temporal trends of this resistance. Four databases (PubMed, Embase, Cochrane Library, Web of Science) were searched for studies on\n                    <jats:italic>B. pertussis<\/jats:italic>\n                    antimicrobial susceptibility through December 2024. Among 57 included studies (1994\u20132024), pooled resistance rates (breakpoint \u226532 mg\/L) were: erythromycin 21% (95% CI 11\u201332%), azithromycin 25% (95% CI 12\u201340%), clarithromycin 15% (95% CI 4\u201330%), and clindamycin 49% (95% CI 28\u201370%). Subgroup analyses by country, year, and test method are presented. No trimethoprim\/sulfamethoxazole (STX) resistance was reported. Six Japanese isolates showed high-level nalidixic acid resistance (MIC &gt;256 mg\/L). Seventy-seven studies contributed to MIC90 data for carbapenems, tetracyclines, aminoglycosides, quinolones, macrolides, cephalosporins, and others. Selected penicillins and intravenous third-generation cephalosporins demonstrated strong in vitro activity, suggesting alternative treatment options. Macrolide-resistant\n                    <jats:italic>B. pertussis<\/jats:italic>\n                    has increased significantly over the past decade. Due to the high burden of antibiotic resistance in China, enhanced surveillance is warranted, while continued monitoring in other countries also remains necessary.\n                  <\/jats:p>","DOI":"10.1017\/s0950268826101010","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T05:39:24Z","timestamp":1770356364000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Antimicrobial resistance in\n                    <i>Bordetella pertussis<\/i>\n                    : A systematic review and meta-analysis"],"prefix":"10.1017","volume":"154","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2623-270X","authenticated-orcid":false,"given":"Keer","family":"Ma","sequence":"first","affiliation":[{"name":"Shaoxing Central Hospital"},{"name":"Shaoxing 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