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Erythromycin-resistant Bordetella pertussis--Yuma County, Arizona, May-October 1994
Abstract:
In 1993, a total of 6586 cases of pertussis was reported in the United States, including 70 in Arizona. On June 27, 1994, a case of Bordetella pertussis disease caused by a strain resistant to erythromycin was reported to the Arizona Department of Health Services (ADHS) from Yuma County (1990 population: 106,895). Susceptibility testing at CDC confirmed that the isolate was highly resistant to erythromycin with a minimum inhibitory concentration (MIC) > 64 micrograms/mL. The MIC of erythromycin against B. pertussis usually ranges from 0.02 micrograms/mL to 0.1 micrograms/mL, and resistant isolates have not been previously reported (1). This report summarizes the case investigation and describes efforts to enhance surveillance for pertussis in Arizona.
Insights
A rare case of erythromycin-resistant Bordetella pertussis was identified in Arizona. This finding highlights the need for enhanced pertussis surveillance to monitor antimicrobial resistance.
Area of Science:
- Public Health
- Microbiology
- Infectious Diseases
Background:
- Pertussis (whooping cough) remains a significant public health concern, with thousands of cases reported annually in the United States.
- Erythromycin is a primary antibiotic used for pertussis treatment.
- Antimicrobial resistance in Bordetella pertussis has not been previously documented.
Observation:
- In 1994, a case of pertussis caused by an erythromycin-resistant strain of Bordetella pertussis was reported in Yuma County, Arizona.
- Laboratory testing confirmed high-level resistance to erythromycin, with a minimum inhibitory concentration (MIC) significantly exceeding typical values.
- This marked the first reported instance of erythromycin resistance in Bordetella pertussis.
Findings:
- The identified Bordetella pertussis isolate exhibited an MIC of > 64 µg/mL for erythromycin.
- This level of resistance is substantially higher than the usual MIC range of 0.02–0.1 µg/mL for susceptible strains.
- The case prompted an investigation into the source and spread of this resistant strain.
Implications:
- The emergence of erythromycin-resistant pertussis necessitates enhanced surveillance strategies to detect and monitor antimicrobial resistance.
- This finding may impact future treatment guidelines and public health interventions for pertussis.
- Further research is needed to understand the mechanisms and prevalence of erythromycin resistance in Bordetella pertussis.