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2013—2014年北京市某区18岁及以下疑似百日咳病例的病原学检测结果分析

Analysis on etiological detection results off suspected pertussis cases aged ≤18 years in a district of Beijing, 2013−2014

    摘要
  • 摘要:
    目的  评估特异性百日咳鲍特菌增菌联合木炭血琼脂培养法（“新培养法”）在北京市某区儿童百日咳监测中的病原检出效能，并分析分离株的耐药特征及病例的分布特征。
    方法 收集2023—2024年北京市某区18岁及以下疑似百日咳病例的鼻咽拭子样本，进行百日咳鲍特菌荧光聚合酶链式反应（PCR）检测和新培养法检测，对两种检测方法结果进行Kappa检验，对分离菌株进行E-test法的药物敏感性检测，对实验室确诊病例的月份分布和年龄分布进行统计分析。
    结果 共收集百日咳疑似病例186例，其中76例可基于荧光PCR法和/或新培养法确诊为百日咳实验室确诊病例，实验室诊断阳性率为40.86%（76/186），荧光PCR法和新培养法阳性检出率分别为38.71%（72/186）和27.42%（51/186），两种检测方法一致性检验结果为较强（Kappa值=0.653，P＜0.001）。百日咳实验室确诊病例中以6～11岁年龄组病例构成比最高（55.26%，42/76）。分离的51株百日咳鲍特菌菌株对磺胺甲恶唑、克林霉素、红霉素、阿奇霉素的最小抑菌浓度均大于最大测试浓度，分别为>1 024 mg/L、>256 mg/L、>256 mg/L、>256 mg/L。
    结论 新培养法具有较好的百日咳鲍特菌分离效果；北京市某区18岁及以下疑似百日咳病例具有较高实验室诊断阳性率，分离的百日咳鲍特菌对磺胺甲恶唑、克林霉素、红霉素、阿奇霉素具有高耐药水平；6～11岁儿童和未完成百日咳基础免疫的儿童是目前百日咳防控的关键人群。应加强百日咳系统性、连续性监测的工作体系建设。

     

    Abstract:
    Objective To evaluate the pathogen detection efficiency of the method based on Bordetella pertussis (B. pertussis)-specific enrichment combined with charcoal blood agar culture ("new culture method") in the surveillance of pertussis in children in a district of Beijing, and analyze the drug resistance characteristics of the isolates and the distribution of the cases.
    Methods Nasopharyngeal swab s were collected from suspected pertussis cases aged ≤18 years in a district of Beijing between January 2023 and December 2024. Fluorescent polymerase chain reaction (PCR) and the new culture method were used for B. pertussis detection. The results of the two detection methods were compared by using Kappa test. Drug susceptibility testing of the isolated strains was conducted by using E-test. Statistical analysis was performed on the monthly and age distributions of laboratory confirmed pertussis cases.
    Results A total of 186 suspected pertussis cases were collected, in which 76 were laboratory confirmed by fluorescent PCR and/or the new culture method. The laboratory confirmation rate was 40.86% (76/186). The detection rates of fluorescent PCR and the new culture method were 38.71% (72/186) and 27.42% (51/186), respectively. The consistency test between the two detection methods showed strong consistency (Kappa value = 0.653, P<0.001). In the laboratory-confirmed pertussis cases, the cases aged 6-11 years accounted for the highest proportion (55.26%, 42/76). The minimum inhibitory concentrations of sulfamethoxazole, clindamycin, erythromycin, and azithromycin to the 51 isolated B. pertussis strains all exceeded the maximum test concentrations, i.e. >1024 mg/L, >256 mg/L, >256 mg/L, and >256 mg/L, respectively.
    Conclusion The new culture method showed good isolation efficiency for B. pertussis. The isolated B. pertussis strains showed high resistance levels to sulfamethoxazole, clindamycin, erythromycin, and azithromycin. Children aged 6–11 years and those who have not completed the basic pertussis immunization are key populations for pertussis prevention and control. More efforts are needed to establish a systematic and continuous surveillance system for pertussis.

     

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