新生儿百日咳临床特点和致病菌耐药性分析

Clinical characteristics of whooping cough in neonates and antimicrobial resistance of the pathogenic bacteria

目的：总结新生儿百日咳的临床特点和致病株的耐药性。方法分析7例新生儿百日咳患儿的临床特点，采用Etest方法和纸片扩散法检测分离株对红霉素等抗生素的敏感性。结果7例患儿中，6例患儿的母亲或祖辈有持续10d以上的咳嗽，其中4例患儿的家庭成员中，≥3人咳嗽。患儿早期均有鼻塞、轻咳症状，5例在病程4-7d出现典型痉挛性咳嗽；5例口唇青紫，4例有呼吸暂停，3例有屏气发作，仅2例有发热表现。可见程度不一的鼻扇、三凹征等呼吸困难表现。分离株中5株在红霉素纸片周围没有形成抑菌环，Etest检查显示红霉素、阿奇霉素、克拉霉素和克林霉素对其的最小抑菌浓度（MIC）均〉256mg/L。结论对于有呼吸道症状，且曾与呼吸道感染患者密切接触的新生儿应警惕百日咳的可能，应详问流行病学史，并及时进行病原学检查；大环内酯类抗生素耐药菌株在百日咳病原菌中已很常见。

Objective To study the clinical characteristics of whooping cough in neonates and the antimicrobial resistance of the bacterial isolates. Methods Clinical information of 7 neonates with whooping cough conifrmed by bacterial culture was collected. The antimirobial resistance of the isolates was tested using E-test and disk diffusion methods. Results The children＆#39;s mothers or other family members had cough for more than 10 days in 6 neonates, in which four neonates contacted with 3 or more family members with cough. All the neonates had rhinobyon and slight cough at the beginning of the disease. Five cases presented typical spasmodic cough after 4-7 days of the onset. Five cases displayed cyanosis, four cases occurred apnea, three cases suffered breath holding, and only two cases had fever. Nares flaring and three depression signs were found in the physical examination. No bacteriostatic ring around the erythromycin disks were found for ifve bacterial isolates. The minimal inhibitory concentration （MIC） for erythromycin, azithromycin, clarithromycin and clindamycin were all〉256 mg/L against the ifve isolates. Conclusions Whooping cough should be considered for neonates with respiratory symptoms and a history of close contact with respiratory infection patients. Macrolide-resistant Bordetella pertussis is common in children with whooping cough.