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Macrolide-Resistant Bordetella pertussis in Hong Kong: Evidence for Post-COVID-19 Emergence of ptxP3-Lineage MT28
Tsz-Yung Hui1,2, Hayes Kam-Hei Luk1, Garnet Kwan-Yue Choi2
1Department of Pathology, Queen Elizabeth Hospital, Hong Kong SAR, China.
Abstract:
A post-COVID surge of Bordetella pertussis was observed globally. China has reported a high level of macrolide-resistant Bordetella pertussis (MRBP) in recent years; however, the epidemiology of MRBP in Hong Kong remains unknown. We retrieved archived B. pertussis isolates from respiratory samples collected at five regional public hospitals in Hong Kong between 2015 and 2024 and tested their minimum inhibitory concentration (MIC) for macrolides and other non-macrolide antibiotics using the Etest method. All isolates were also subjected to whole genome sequencing for genotypic resistance, Multi-locus Antigen Sequence Typing (MLST) and Multi-locus Variable Number of Tandem Repeat Analysis (MLVA) typing. Twenty-nine isolates of B. pertussis were included in the study. All isolates demonstrating phenotypic macrolide resistance harbored the A2047G mutation while showing low MIC to trimethoprim-sulfamethoxazole, doxycycline, levofloxacin, piperacillin-tazobactam and meropenem. In 2023 and 2024, 100% were MRBP and all belonged to the MT28 clone with the ptxP3 antigenic type. The MRBP isolates in Hong Kong were phylogenetically related to those from mainland China during the same period. There was no obvious correlation between macrolide resistance and clinical presentation, laboratory findings, management and outcome. Phylogenetic analysis suggests that MRBP isolates in Hong Kong and mainland China are closely related.
Insights
Macrolide-resistant Bordetella pertussis (MRBP) has emerged in Hong Kong, with 100% of isolates in 2023-2024 resistant. These Hong Kong MRBP strains are phylogenetically linked to those in mainland China.
Area of Science:
- Microbiology
- Genetics
- Epidemiology
Background:
- A global increase in Bordetella pertussis cases has been observed post-COVID-19.
- High rates of macrolide-resistant Bordetella pertussis (MRBP) have been reported in China.
- The epidemiology of MRBP in Hong Kong was previously unknown.
Purpose of the Study:
- To investigate the prevalence and characteristics of MRBP in Hong Kong.
- To determine the genetic basis of macrolide resistance in Bordetella pertussis isolates from Hong Kong.
- To understand the phylogenetic relationship of Hong Kong MRBP isolates with those from other regions.
Main Methods:
- Retrieved archived Bordetella pertussis isolates from Hong Kong public hospitals (2015-2024).
- Determined minimum inhibitory concentrations (MICs) for macrolides and other antibiotics using Etest.
- Performed whole genome sequencing for genotypic resistance, MLST, and MLVA typing.
Main Results:
- Twenty-nine Bordetella pertussis isolates were analyzed.
- All macrolide-resistant isolates harbored the A2047G mutation and showed low MICs to alternative antibiotics.
- From 2023-2024, 100% of isolates were MRBP, belonging to the MT28 clone with ptxP3 antigenic type.
- Hong Kong MRBP isolates were phylogenetically related to those from mainland China.
Conclusions:
- Macrolide resistance in Bordetella pertussis is prevalent in Hong Kong, primarily driven by the A2047G mutation.
- The MT28 clone with ptxP3 antigenic type dominates recent MRBP isolates in Hong Kong.
- MRBP strains in Hong Kong share a close phylogenetic relationship with those circulating in mainland China.
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