{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:54:42Z","timestamp":1781639682042,"version":"3.54.5"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":55,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Sanming Project of Medicine in Shenzhen, China","award":["SZSM202311024"],"award-info":[{"award-number":["SZSM202311024"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Recently, macrolide-resistant\n                      <jats:italic>Bordetella pertussis<\/jats:italic>\n                      (MRBP) had emerged in China. The aim of this study was to evaluate the prevalence and clinical characteristics of MRBP in Shenzhen, southern China.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We enrolled patients with culture-confirmed pertussis at Shenzhen Children\u2019s Hospital from January 2016 to December 2023. Demographic and clinical data of the patients were collected. The antimicrobial susceptibility of\n                      <jats:italic>Bordetella pertussis<\/jats:italic>\n                      isolates was evaluated, and the minimum inhibitory concentrations (MICs) against erythromycin, trimethoprim-sulfamethoxazole (TMP-SMZ), levofloxacin, ampicillin, and ceftriaxone were determined using the E-test method. Patients were categorized into macrolide-resistant (MR) and macrolide-sensitive (MS) groups according to the erythromycin susceptibility of their isolates. Group comparisons were performed using the Mann-Whitney U test or chi-square test, as appropriate. Multivariable logistic regression was performed to identify factors independently associated with MRBP infection. A two-sided\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 678 patients were enrolled. The MIC\n                      <jats:sub>90<\/jats:sub>\n                      of erythromycin, TMP-SMZ, levofloxacin, ampicillin, and ceftriaxone was &gt;\u2009256\u00a0mg\/L, 0.38\u00a0mg\/L, 0.5\u00a0mg\/L, 1\u00a0mg\/L, 0.25\u00a0mg\/L, respectively. The proportion of MRBP strains significantly increased after early 2020 (44.5% in 2016\u20132019 vs. 89.1% in 2020\u20132023,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Compared with the MS group, the MR group was older and had higher diphtheria-tetanus-acellular pertussis (DTaP) vaccination rate, longer hospital stay, longer antibiotic use before culture and during hospitalization, more TMP-SMZ use, and more persistently positive cultures (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Binary logistic regression including age, study period, and DTaP vaccination status showed that only the study period (2020\u20132023 vs. 2016\u20132019) was independently associated with MRBP infection (OR\u2009=\u20099.516, 95% CI 5.738\u201315.781,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The prevalence of MRBP increased markedly in southern China after the COVID-19 pandemic. TMP-SMZ, levofloxacin, ampicillin, and ceftriaxone remained effective against\n                      <jats:italic>B. pertussis<\/jats:italic>\n                      in vitro. MRBP infection was associated with greater antibiotic exposure, longer hospitalization, TMP-SMZ use, and persistently positive cultures.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-026-12911-9","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T13:32:44Z","timestamp":1772544764000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiological and clinical characteristics of macrolide-resistant Bordetella pertussis in southern China: an 8-year retrospective study"],"prefix":"10.1186","volume":"26","author":[{"given":"Zengrui","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongmei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuijuan","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangcheng","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinjun","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinxin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchun","family":"Long","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shufeng","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biao","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jikui","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"issue":"3","key":"12911_CR1","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1128\/CMR.00083-15","volume":"29","author":"PE Kilgore","year":"2016","unstructured":"Kilgore PE, Salim AM, Zervos MJ, Schmitt HJ. Pertussis: Microbiology, Disease, Treatment, and Prevention. Clin Microbiol Rev. 2016;29(3):449\u201386.","journal-title":"Clin Microbiol Rev"},{"issue":"Suppl 1","key":"12911_CR2","doi-asserted-by":"publisher","first-page":"S119","DOI":"10.1016\/j.jinf.2013.09.022","volume":"68","author":"N Guiso","year":"2014","unstructured":"Guiso N. Bordetella pertussis: why is it still circulating? J Infect. 2014;68(Suppl 1):S119\u201324.","journal-title":"J Infect"},{"issue":"2","key":"12911_CR3","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s100960050435","volume":"19","author":"JR Kerr","year":"2000","unstructured":"Kerr JR, Matthews RC. Bordetella pertussis infection: pathogenesis, diagnosis, management, and the role of protective immunity. Eur J Clin Microbiol Infect Dis. 2000;19(2):77\u201388.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"1","key":"12911_CR4","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1093\/cid\/ciz531","volume":"70","author":"R Craig","year":"2020","unstructured":"Craig R, Kunkel E, Crowcroft NS, et al. Asymptomatic Infection and Transmission of Pertussis in Households: A Systematic Review. Clin Infect Dis. 2020;70(1):152\u201361.","journal-title":"Clin Infect Dis"},{"issue":"1","key":"12911_CR5","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.jinf.2016.09.002","volume":"74","author":"I Jordan","year":"2017","unstructured":"Jordan I, Felipe A, Balaguer M, et al. Morbidity and mortality risk factors of pertussis in pediatrics. J Infect. 2017;74(1):97\u2013100.","journal-title":"J Infect"},{"issue":"7","key":"12911_CR6","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1016\/S1473-3099(11)70007-X","volume":"11","author":"F Zepp","year":"2011","unstructured":"Zepp F, Heininger U, Mertsola J, et al. Rationale for pertussis booster vaccination throughout life in Europe. Lancet Infect Dis. 2011;11(7):557\u201370.","journal-title":"Lancet Infect Dis"},{"issue":"11","key":"12911_CR7","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.3390\/antibiotics11111570","volume":"11","author":"L Ivaska","year":"2022","unstructured":"Ivaska L, Barkoff AM, Mertsola J, He Q. Macrolide Resistance in Bordetella pertussis: Current Situation and Future Challenges. Antibiot (Basel). 2022;11(11):1570.","journal-title":"Antibiot (Basel)"},{"issue":"Suppl 5","key":"12911_CR8","doi-asserted-by":"publisher","first-page":"S96","DOI":"10.1016\/j.cmi.2016.05.029","volume":"22","author":"C Locht","year":"2016","unstructured":"Locht C. Live pertussis vaccines: will they protect against carriage and spread of pertussis? Clin Microbiol Infect. 2016;22(Suppl 5):S96\u2013102.","journal-title":"Clin Microbiol Infect"},{"issue":"RR\u201314","key":"12911_CR9","first-page":"1","volume":"54","author":"T Tiwari","year":"2005","unstructured":"Tiwari T, Murphy TV, Moran J. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC Guidelines. MMWR Recomm Rep. 2005;54(RR\u201314):1\u201316.","journal-title":"MMWR Recomm Rep"},{"issue":"8","key":"12911_CR10","first-page":"568","volume":"55","author":"Subspecialty Group of Infectious Diseases, the Society of Pediatrics, Chinese Medical Association","year":"2017","unstructured":"Subspecialty Group of Infectious Diseases, the Society of Pediatrics, Chinese Medical Association. Editorial Board, Chinese Journal of Pediatrics. Recommendation for diagnosis and treatment of Chinese children with pertussis. Zhonghua Er Ke Za Zhi. 2017;55(8):568\u201372.","journal-title":"Zhonghua Er Ke Za Zhi"},{"key":"12911_CR11","first-page":"100098","volume":"8","author":"Y Feng","year":"2021","unstructured":"Feng Y, Chiu CH, Heininger U, Hozbor DF, Tan TQ, K\u00f6nig CW. Emerging Macrolide Resistance in Bordetella Pertussis in Mainland China: Findings and warning from the global pertussis initiative. Lancet Reg Health West Pac. 2021;8:100098.","journal-title":"Lancet Reg Health West Pac"},{"issue":"1","key":"12911_CR12","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3201\/eid3001.221588","volume":"30","author":"P Fu","year":"2023","unstructured":"Fu P, Zhou J, Yang C, et al. Molecular evolution and increasing macrolide resistance of Bordetella pertussis, Shanghai, China, 2016\u20132022. Emerg Infect Dis. 2024;30(1):29\u201338.","journal-title":"Emerg Infect Dis"},{"issue":"2","key":"12911_CR13","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1016\/j.jinf.2021.12.023","volume":"84","author":"Y Geng","year":"2022","unstructured":"Geng Y, Zhang L. Impact of non-pharmaceutical interventions during COVID-19 pandemic on pertussis, scarlet fever and hand-foot-mouth disease in China. J Infect. 2022;84(2):e13\u20135.","journal-title":"J Infect"},{"issue":"49","key":"12911_CR14","doi-asserted-by":"publisher","first-page":"2400765","DOI":"10.2807\/1560-7917.ES.2024.29.49.2400765","volume":"29","author":"M Miettinen","year":"2024","unstructured":"Miettinen M, Barkoff AM, Nyqvist A, et al. Macrolide-resistant Bordetella pertussis strain identified during an ongoing epidemic, Finland, January to October 2024. Euro Surveill. 2024;29(49):2400765.","journal-title":"Euro Surveill"},{"issue":"31","key":"12911_CR15","doi-asserted-by":"publisher","first-page":"2400459","DOI":"10.2807\/1560-7917.ES.2024.29.31.2400459","volume":"29","author":"C Rodrigues","year":"2024","unstructured":"Rodrigues C, Bouchez V, Soares A, et al. Resurgence of Bordetella pertussis, including one macrolide-resistant isolate, France, 2024. Euro Surveill. 2024;29(31):2400459.","journal-title":"Euro Surveill"},{"key":"12911_CR16","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.jgar.2022.10.007","volume":"31","author":"K Koide","year":"2022","unstructured":"Koide K, Yao S, Chiang CS, et al. Genotyping and macrolide-resistant mutation of Bordetella pertussis in East and South-East Asia. J Glob Antimicrob Resist. 2022;31:263\u20139.","journal-title":"J Glob Antimicrob Resist"},{"issue":"7","key":"12911_CR17","first-page":"e18190","volume":"8","author":"B Mirzaei","year":"2015","unstructured":"Mirzaei B, Bameri Z, Babaei R, Shahcheraghi F. Isolation of High Level Macrolide Resistant Bordetella pertussis Without Transition Mutation at Domain V in Iran. Jundishapur J Microbiol. 2015;8(7):e18190.","journal-title":"Jundishapur J Microbiol"},{"issue":"2","key":"12911_CR18","doi-asserted-by":"publisher","first-page":"e0298147","DOI":"10.1371\/journal.pone.0298147","volume":"19","author":"K Koide","year":"2024","unstructured":"Koide K, Uchitani Y, Yamaguchi T, et al. Whole-genome comparison of two same-genotype macrolide-resistant Bordetella pertussis isolates collected in Japan. PLoS ONE. 2024;19(2):e0298147.","journal-title":"PLoS ONE"},{"issue":"7","key":"12911_CR19","doi-asserted-by":"publisher","first-page":"102727","DOI":"10.1016\/j.jiac.2025.102727","volume":"31","author":"T Iwasaki","year":"2025","unstructured":"Iwasaki T, Koide K, Kido T, et al. Fatal case of macrolide-resistant Bordetella pertussis infection, Japan, 2024. J Infect Chemother. 2025;31(7):102727.","journal-title":"J Infect Chemother"},{"issue":"15","key":"12911_CR20","first-page":"1258","volume":"104","author":"Pediatric Infection Group","year":"2024","unstructured":"Pediatric Infection Group, Chinese Society of Infectious Diseases, Infection Group, Pediatric Expert Committee of National Health Commission Capacity Building and Continuing Education, National Medical Center for Infectious Diseases. Guidelines for diagnosis and management and prevention of pertussis of China (2024 edition). Zhonghua Yi Xue Za Zhi. 2024;104(15):1258\u201379.","journal-title":"Zhonghua Yi Xue Za Zhi"},{"issue":"1","key":"12911_CR21","doi-asserted-by":"publisher","first-page":"2475841","DOI":"10.1080\/22221751.2025.2475841","volume":"14","author":"Y Hu","year":"2025","unstructured":"Hu Y, Zhou L, Du Q, et al. Sharp rise in high-virulence Bordetella pertussis with macrolides resistance in Northern China. Emerg Microbes Infect. 2025;14(1):2475841.","journal-title":"Emerg Microbes Infect"},{"key":"12911_CR22","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jgar.2019.01.029","volume":"18","author":"CZ Hua","year":"2019","unstructured":"Hua CZ, Wang HJ, Zhang Z, et al. 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. J Glob Antimicrob Resist. 2019;18:47\u201351.","journal-title":"J Glob Antimicrob Resist"},{"issue":"2","key":"12911_CR23","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1097\/INF.0000000000002911","volume":"40","author":"YM Mi","year":"2021","unstructured":"Mi YM, Hua CZ, Fang C, et al. Effect of Macrolides and \u03b2-lactams on Clearance of Bordetella pertussis in the Nasopharynx in Children With Whooping Cough. Pediatr Infect Dis J. 2021;40(2):87\u201390.","journal-title":"Pediatr Infect Dis J"},{"issue":"9","key":"12911_CR24","doi-asserted-by":"publisher","first-page":"e0138941","DOI":"10.1371\/journal.pone.0138941","volume":"10","author":"Y Yang","year":"2015","unstructured":"Yang Y, Yao K, Ma X, Shi W, Yuan L, Yang Y. Variation in Bordetella pertussis Susceptibility to Erythromycin and Virulence-Related Genotype Changes in China (1970\u20132014). PLoS ONE. 2015;10(9):e0138941.","journal-title":"PLoS ONE"},{"issue":"4","key":"12911_CR25","doi-asserted-by":"publisher","first-page":"282","DOI":"10.21101\/cejph.a4948","volume":"25","author":"V Jakub\u016f","year":"2017","unstructured":"Jakub\u016f V, Zavadilov\u00e1 J, Fabi\u00e1nov\u00e1 K, Urb\u00e1\u0161kov\u00e1 P. Trends in the Minimum Inhibitory Concentrations of Erythromycin, Clarithromycin, Azithromycin, Ciprofloxacin, and Trimethoprim\/Sulfamethoxazole for Strains of Bordetella pertussis isolated in the Czech Republic in 1967\u20132015. Cent Eur J Public Health. 2017;25(4):282\u20136.","journal-title":"Cent Eur J Public Health"},{"issue":"12","key":"12911_CR26","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.3201\/eid2512.181836","volume":"25","author":"L Li","year":"2019","unstructured":"Li L, Deng J, Ma X, et al. High Prevalence of Macrolide-Resistant Bordetella pertussis and ptxP1 Genotype, Mainland China, 2014\u20132016. Emerg Infect Dis. 2019;25(12):2205\u201314.","journal-title":"Emerg Infect Dis"},{"issue":"4","key":"12911_CR27","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1111\/apm.12357","volume":"123","author":"Y Li","year":"2015","unstructured":"Li Y, Liu X, Zhang B, He Q, Wang Z. Where macrolide resistance is prevalent. APMIS. 2015;123(4):361\u20133.","journal-title":"APMIS"},{"issue":"7","key":"12911_CR28","doi-asserted-by":"publisher","first-page":"3147","DOI":"10.1128\/AAC.00023-09","volume":"53","author":"M Ohtsuka","year":"2009","unstructured":"Ohtsuka M, Kikuchi K, Shimizu K, et al. Emergence of quinolone-resistant Bordetella pertussis in Japan. Antimicrob Agents Chemother. 2009;53(7):3147\u20139.","journal-title":"Antimicrob Agents Chemother"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-026-12911-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-12911-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-12911-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:15:18Z","timestamp":1781637318000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12879-026-12911-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["12911"],"URL":"https:\/\/doi.org\/10.1186\/s12879-026-12911-9","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]},"assertion":[{"value":"16 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the ethics committee of Shenzhen Children\u2019s Hospital (Ethical approval number: 202300082). This study was performed in accordance with the principles of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"837"}}