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目的:了解儿童百日咳鲍特菌感染的临床特点、菌株体外耐药模式和治疗效果，为百日咳的诊治提供参考。方法:采集2017年浙江大学医学院附属儿童医院临床疑诊为百日咳的住院患儿的鼻咽拭子培养百日咳鲍特菌，并收集患儿的临床表现资料，菌株以百日咳特异性抗血清凝集试验鉴定，并经质谱分析最终确认。药物敏感试验采用E-test法，抗菌药物治疗2周评价疗效。统计学分析采用曼-惠特尼n U检验和n χ2检验。n 结果:1 029例患儿中211例(20.5%)鼻咽拭子培养百日咳鲍特菌阳性，7月份分离率最高[31.2%(45/144)]。211例患儿中，男105例(49.8%)，女106例(50.2%)，年龄为3.8(2.2，6.9)个月，114例(54.0%)未接种百白破混合疫苗。192例(91.0%)患儿在标本采集前曾使用抗菌药物，142例(67.3%)来自多孩家庭，其中136例(95.8%)为家庭中的幼子。159例(75.4%)夜间阵发性咳嗽剧烈，61例(28.9%)咳嗽后有鸡鸣样回声。白细胞计数>20×10n 9/L、淋巴细胞计数>10×10n 9/L的患儿分别为94例(44.5%)和97例(46.0%)。红霉素、阿奇霉素和克林霉素对138株(65.4%)菌株的最低抑菌浓度(minimum inhibitory concentration，MIC)均>256.000 mg/L。氨苄西林、头孢曲松、头孢哌酮/舒巴坦、美罗培南和甲氧苄啶/磺胺甲基异口恶唑对菌株的MICn 90分别为0.190、0.190、0.094、0.094和0.750 mg/L；哌拉西林/他唑巴坦对所有菌株的MIC均256.000 mg/L. The MICn 90 of the isolates to ampicillin, ceftriaxone, cefoperazone/sulbactam, meropenem and trimethoprim/sulfamethoxazole were 0.190 mg/L, 0.190 mg/L, 0.094 mg/L, 0.094 mg/L and 0.750 mg/L, respectively. All strains had a MIC of <0.016 mg/L for piperacillin/tazobactam. After treatment, symptoms were improved in 195(92.4%) patients when they were discharged from hospital. Seventy-six (57.1%) children whose symptoms did not improve after seven-day treatment with macrolides, were prescribed with other antibiotics or other antibiotic with macrolides in combination. Compared with the patients treated with macrolides, more patients treated with cefoperazone/sulbactam or piperacillin/tazobactam had negative nasopharyngeal culture results after two weeks of therapy (46/48(95.8%) n vs 46/57(80.7%)), or on day seven (45/46(97.8%) n vs 39/47(83.0%)) and on day 14 (45/45(100.0%) n vs 41/47(87.2%)) since discharged. The differences were all statistically significant (n χ2=5.50, 5.86 and 6.15, respectively, n P=0.019, 0.015 and 0.013, respectively).n Conclusions:The majority of children with pertussis do not have whooping, and the resistant rate of n Bordetella pertussis to macrolides is high. Further study is needed to evaluate the feasibility and reasonability of cefoperazone/sulbactam and piperacillin/tazobactam in treating pediatric pertussis caused by macrolides-resistant n Bordetella pertussis.n