青少年社区获得性肺炎中耐大环内酯类肺炎支原体。
Macrolide-resistant Mycoplasma pneumoniae in adolescents with community-acquired pneumonia.
机构信息
Department of Internal Medicine , Kawasaki Medical School, Okayama, Japan.
出版信息
BMC Infect Dis. 2012 May 31;12:126. doi: 10.1186/1471-2334-12-126.
BACKGROUND
Although the prevalence of macrolide-resistant Mycoplasma pneumoniae isolates in Japanese pediatric patients has increased rapidly, there have been no reports concerning macrolide-resistant M. pneumoniae infection in adolescents aged 16 to 19 years old. The purpose of this study was to clarify the prevalence and clinical characteristics of macrolide-resistant M. pneumoniae in adolescent patients with community-acquired pneumonia.
METHODS
A total of 99 cases with M. pneumoniae pneumonia confirmed by polymerase chain reaction (PCR) and culture were analyzed. Forty-five cases were pediatric patients less than 16 years old, 26 cases were 16 to 19-year-old adolescent patients and 28 cases were adult patients. Primers for domain V of 23S rRNA were used and DNA sequences of the PCR products were compared with the sequence of an M. pneumoniae reference strain.
RESULTS
Thirty of 45 pediatric patients (66%), 12 of 26 adolescent patients (46%) and seven of 28 adult patients (25%) with M. pneumoniae pneumonia were found to be infected with macrolide-resistant M. pneumoniae (MR patients). Although the prevalence of resistant strains was similar in pediatric patients between 2008 and 2011, an increase in the prevalence of resistant strains was observed in adolescent patients. Among 30 pediatric MR patients, 26 had an A-to-G transition at position 2063 (A2063G) and four had an A-to-G transition at position 2064 (A2064G). In 12 adolescent MR patients, 10 showed an A2063G transition and two showed an A2064G transition, and in seven adult MR patients, six showed an A2063G transition and one showed an A2064G transition.
CONCLUSIONS
The prevalence of macrolide-resistant M. pneumoniae is high among adolescent patients as well as pediatric patients less than 16-years old. To prevent outbreaks of M. pneumoniae infection, especially macrolide-resistant M. pneumoniae, in closed populations including among families, in schools and in university students, physicians should pay close attention to macrolide-resistant M. pneumoniae.
背景
虽然日本儿科患者中对大环内酯类耐药的肺炎支原体分离株的流行率迅速上升，但尚未有关于 16 至 19 岁青少年中对大环内酯类耐药的肺炎支原体感染的报告。本研究的目的是阐明社区获得性肺炎中青少年患者对大环内酯类耐药的肺炎支原体的流行率和临床特征。
方法
分析了经聚合酶链反应（PCR）和培养证实的 99 例肺炎支原体肺炎病例。45 例为 16 岁以下的儿科患者，26 例为 16 至 19 岁的青少年患者，28 例为成年患者。使用 23S rRNA 结构域 V 的引物，比较 PCR 产物的 DNA 序列与肺炎支原体参考株的序列。
结果
45 例儿科患者中有 30 例（66%）、26 例青少年患者中有 12 例（46%）和 28 例成年患者中有 7 例（25%）感染了对大环内酯类耐药的肺炎支原体（MR 患者）。虽然 2008 年至 2011 年儿科患者中耐药菌株的流行率相似，但在青少年患者中观察到耐药菌株的流行率增加。在 30 例儿科 MR 患者中，26 例在位置 2063 处发生 A 到 G 的转换（A2063G），4 例在位置 2064 处发生 A 到 G 的转换（A2064G）。在 12 例青少年 MR 患者中，10 例发生 A2063G 转换，2 例发生 A2064G 转换，在 7 例成年 MR 患者中，6 例发生 A2063G 转换，1 例发生 A2064G 转换。
结论
青少年患者与 16 岁以下的儿科患者一样，对大环内酯类耐药的肺炎支原体的流行率较高。为了预防包括家庭、学校和大学生在内的封闭人群中肺炎支原体感染，特别是对大环内酯类耐药的肺炎支原体感染的爆发，医生应密切关注对大环内酯类耐药的肺炎支原体。
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