Matsuda Children's Clinic, Fukuoka, Japan.
BMC Infect Dis. 2013 Dec 16;13:591. doi: 10.1186/1471-2334-13-591.
Recent epidemiologic data suggest that the prevalence of macrolide resistant Mycoplasma pneumoniae (MR-M. pneumoniae) is increasing rapidly worldwide. This study assessed the present status of M. pneumoniae infection in Japan and clinical end-points to distinguish children with MR-M. pneumoniae.
During an outbreak of M. pneumoniae infections in Fukuoka, Japan in 2010-11, a total of 105 children with clinically suspected M. pneumoniae infection were enrolled. M. pneumoniae was analyzed for macrolide resistance in domain V of the 23S rRNA gene. Sixty -five patients with PCR positive for M. pneumoniae were analyzed with regard to clinical symptoms, efficacy of several antimicrobial agents and several laboratory data.
Causative pathogens were detected in 81.0% (85 of 105) and M. pneumoniae was identified 61.9% (65 of 105). The resistance rate of M. pneumoniae was 89.2% (58 of 65) in this general pediatric outpatient setting. Patients infected with MR-M. pneumoniae showed longer times to resolution of fever and required frequent changes of the initially prescribed macrolide to another antimicrobial agent. We observed three different genotypes of M. pneumoniae including the rarely reported A2063T mutation (A2063G: 31 strains, A2063T: 27 strains, no mutation: 7 strains). Drug susceptibility testing showed different antimicrobial susceptibility profiles for each genotype. Serum IFN-gamma, IL-6 and IP-10 levels were higher in patients with MR-genotypes than in those infected with no-mutation strains (p < 0.001).
Macrolide resistance is more common than previously thought and a small epidemic of rarely reported A2063T mutation was observed in Fukuoka, Japan. Furthermore our results reveal the possibility that levels of certain inflammatory cytokines may be a candidate to predict MR-M.pneumoniae infection.
最近的流行病学数据表明，全球范围内大环内酯类耐药肺炎支原体（MR-M. pneumoniae）的流行率正在迅速上升。本研究评估了日本目前 M. pneumoniae 感染的状况，并确定了区分儿童 MR-M. pneumoniae 的临床终点。
在 2010-11 年日本福冈 M. pneumoniae 感染爆发期间，共纳入 105 例临床疑似 M. pneumoniae 感染的儿童。在域 V 中分析 23S rRNA 基因的大环内酯类耐药性。对 65 例 M. pneumoniae PCR 阳性的患者进行了临床症状、几种抗菌药物的疗效和几项实验室数据的分析。
在 105 例患者中，81.0%（85 例）检测到病原体，61.9%（65 例）鉴定为 M. pneumoniae。在这个普通儿科门诊环境中，M. pneumoniae 的耐药率为 89.2%（58 例/65 例）。感染 MR-M. pneumoniae 的患者退热时间较长，需要频繁更换最初开的大环内酯类药物。我们观察到三种不同的 M. pneumoniae 基因型，包括罕见报道的 A2063T 突变（A2063G：31 株，A2063T：27 株，无突变：7 株）。药敏试验显示每种基因型的抗菌药物敏感性不同。MR 基因型患者的血清 IFN-γ、IL-6 和 IP-10 水平高于无突变株感染患者（p<0.001）。
大环内酯类耐药比以前认为的更为常见，在日本福冈观察到了一种罕见报道的 A2063T 突变的小流行。此外，我们的结果表明，某些炎症细胞因子的水平可能是预测 MR-M.pneumoniae 感染的候选指标。
