Bao Fang, Qu Jiu-xin, Liu Zhen-jia, Qin Xuan-guang, Cao Bin
Department of Pediatrics, Department of Infectious Diseases & Clinical Microbiology, Beijing Chaoyang Hospital, the Affiliated Hospital of Capital Medical University, Beijing 100020, China.
Department of Pediatrics, Department of Infectious Diseases & Clinical Microbiology, Beijing Chaoyang Hospital, the Affiliated Hospital of Capital Medical University, Beijing 100020, China. Email:
Zhonghua Jie He He Hu Xi Za Zhi. 2013 Oct;36(10):756-61.
To investigate the drug resistance of Mycoplasma pneumoniae among children with community-acquired pneumonia (CAP), and to explore the clinical and radiological characteristics of and the role of azithromycin in the treatment of of macrolide-resistant (MR) Mycoplasma pneumoniae pneumonia.
Cases of CAP in children (n = 179) were prospectively enrolled in the Pediatric ward of Beijing Chaoyang Hospital from 1st September, 2010 to 31st August 2011. Pharyngeal swabs were collected for detection of Mycoplasma pneumoniae DNA. Mycoplasma pneumoniae culture and in vitro susceptibility testing were also performed.
Eighty-three cases met the diagnostic criteria of mycoplasma pneumonia, accounting for 46% of the CAP patients. Mycoplasma pneumoniae culture was positive in 45 cases, including 44 highly resistant to macrolides (MR) in vitro, and 1 sensitive. The 44 cases caused by MR pathogen presented with fever for (8 ± 3) d and cough for (17 ± 5) d, with higher fever (39.5 ± 0.7) °C and more irritating dry cough. In most of the children, peripheral blood leukocytes (8 ± 4)×10(9)/L were normal, with normal or elevated (0.60 ± 0.94) neutrophils, normal or slightly elevated erythrocyte sedimentation rate [(24 ± 14) mm/1 h] and CRP (12.8 mg/L). Chest X-ray showed lobar consolidation in 10 cases (23%, 10/44), among them 3 in the lower left lung, 2 in the left lung, 3 in the right lower lung, 2 in the right upper lung. Pleural effusion (small amount), combined with right lower lung consolidation, was found in 1 case. Patchy shadows were found in 27 cases, and interstitial lung infiltrate in 7 cases. Of the 44 cases caused by MR Mycoplasma pneumoniae, 19 had lung computed tomography (CT) scanning, among them 13 had lobar or segmental consolidation. Azithromycin therapy started in an average of 4.0 days after onset of illness, with duration of therapy averaging (9 ± 4) d. Cephalosporin or penicillin (n = 1) was the initial antibiotic choice in 12 of them, while combination therapy with azithromycin and cephalosporin or penicillin antibiotics was given in 41 of them. The duration of fever averaged (6 ± 3) d after treatment of azithromycin and duration of cough averaged (17 ± 5) d after treatment. Among patients with MR Mycoplasma pneumonia, those with lobar consolidation had longer duration of fever after treatment with azithromycin, compared with those without consolidation (P < 0.05).
The macrolide resistance rate was 98% (44/45) in our patients. Fever and duration of therapy with azithromycin in MR infection was longer in patients with lobar consolidation. The 44 children with MR Mycoplasma pneumonia recovered with no serious complications.
探讨社区获得性肺炎（CAP）患儿肺炎支原体的耐药情况，分析大环内酯类耐药（MR）肺炎支原体肺炎的临床及影像学特征，以及阿奇霉素在其治疗中的作用。
前瞻性纳入2010年9月1日至2011年8月31日在北京朝阳医院儿科病房住院的CAP患儿179例。采集咽拭子检测肺炎支原体DNA，同时进行肺炎支原体培养及体外药敏试验。
83例符合支原体肺炎诊断标准，占CAP患儿的46%。肺炎支原体培养阳性45例，其中44例体外对大环内酯类高度耐药（MR），1例敏感。44例由MR病原体引起的患儿发热（8±3）天，咳嗽（17±5）天，发热程度较高（39.5±0.7）℃，刺激性干咳更为明显。多数患儿外周血白细胞（8±4）×10⁹/L正常，中性粒细胞（0.60±0.94）正常或升高，血沉[（24±14）mm/1h]及CRP（12.8mg/L）正常或轻度升高。胸部X线显示大叶实变10例（23%，10/44），其中左下肺3例，左肺2例，右下肺3例，右上肺2例。1例合并少量胸腔积液，伴右下肺实变。斑片状阴影27例，间质性肺浸润7例。44例由MR肺炎支原体引起的患儿中，19例行肺部计算机断层扫描（CT），其中13例有大叶或节段性实变。阿奇霉素治疗平均在发病后4.0天开始，疗程平均（9±
4）天。12例初始抗生素选择为头孢菌素或青霉素（n = 1），41例采用阿奇霉素与头孢菌素或青霉素联合治疗。阿奇霉素治疗后发热平均持续（6±3）天，咳嗽平均持续（17±5）天。MR肺炎支原体患儿中，有大叶实变者阿奇霉素治疗后发热持续时间较无实变者长（P<0.05）。
本研究中患儿大环内酯类耐药率为98%（44/45）。MR感染中，有大叶实变的患儿阿奇霉素治疗的发热时间及疗程更长。44例MR肺炎支原体肺炎患儿均康复，无严重并发症。
