Macrolide Resistance in Bordetella pertussis: Current Situation and Future Challenges

Abstract

Pertussis is a highly contagious respiratory infection caused by Bordetella pertussis bacterium. The mainstay of treatment is macrolide antibiotics that reduce transmissibility, shorten the duration of symptoms and decrease mortality in infants. Recently, the macrolide resistance of B. pertussis has been reported globally but is especially widespread in mainland China. In this review, we aim to summarise the current understanding of the epidemiology, resistance mechanisms and clinical implications of B. pertussis macrolide resistance. Since the first appearance of macrolide-resistant B. pertussis in Arizona, USA, in 1994, only sporadic cases have been reported outside China. In certain parts of China, on the other hand, up to 70–100% of the recent clinical isolates have been found to be macrolide resistant. Reasons for macrolide resistance being centred upon China during the last decade can only be speculated on, but the dominant B. pertussis lineage is different between China and most of the high-income countries. It seems evident that efforts to increase awareness, guide molecular epidemiological surveillance and carry out systematic screening of B. pertussis positive samples for macrolide resistance should be implemented globally. In addition, practices to improve the clinical care of infants with pertussis caused by resistant strains should be studied vigorously.

Resurgence of Bordetella pertussis, including one macrolide-resistant isolate, France, 2024

“…Until now, macrolide resistance has seldom been reported, with the notable exception of Asia and more particularly China, where such isolates have become highly prevalent in the last years [ 19 ]. Only one Bp isolate had previously been reported in France (and in Europe) in 2011 [ 6 ].…”

Whole-genome comparison of two same-genotype macrolide-resistant Bordetella pertussis isolates collected in Japan

“…However, macrolide-resistant B . pertussis (MRBP) has been detected in several countries [ 1 ]. MRBP was first identified in Arizona, USA, in 1994 [ 2 ].…”

“…Macrolides such as erythromycin and clarithromycin are recommended antimicrobial agents for the treatment of pertussis. However, macrolide-resistant B. pertussis (MRBP) has been detected in several countries [1]. MRBP was first identified in Arizona, USA, in 1994 [2].…”

Molecular Evolution and Increasing Macrolide Resistance of Bordetella pertussis, Shanghai, China, 2016–2022

“…In many countries, circulating B. pertussis harbors different virulence genotypes compared with vaccine strains ( 15 , 16 ). Different alleles of ptxP , fhaB, ptxA, ptxC , fim2 , and fim3 have been reported in many studies ( 6 , 17 , 18 ).…”

“…However, MT27 has seldomly been reported in China, whereas the MT55, MT195, or MT104 strains harboring the ptxP1 allele have been reported to circulate in some regions of China ( 23 , 24 ). Macrolide-resistant B. pertussis (MRBP), which carries an A-to-G transition at nucleotide position 2047 (A2047G mutation) in a region critical for erythromycin binding, emerged in some countries, but was only frequently detected in China ( 15 , 16 , 25 – 27 ). MRBPs generally carry ptxP1 and fhaB3 , but 2 novel MRBPs belonging to MT28 and MT27 carrying ptxP3 and fhaB1 were reported in mainland China ( 15 , 28 ).…”