Yu Hong-Xia, Zhao Mao-Mao, Pu Zeng-Hui, Ju Yuan-Rong, Liu Yan
Pneumology Department, Shandong Provincial Hospital. Shandong University, Jinan, China.
Department of Infectious Diseases, Yantai Yuhuangding Hospital. Qingdao University, Yantai, China.
Colomb Med (Cali). 2018 Jun 30;49(2):160-163. doi: 10.25100/cm.v49i2.3813.
Community-acquired pneumonia (CAP) is a global disease responsible for a large number of deaths, with significant economic impact. As diagnostic tools have increased in sensitivity, understanding of the etiology of CAP has begun to change. is one of the major pathogens causing CAP. Macrolides and related antibiotics are first-line treatments for . Macrolide resistance has been spreading for 15 years and now occurs in worldwide. We undertook the first study on macrolide resistance of in Yantai. This may be helpful to determine the appropriate therapy for CAP in this population.
To investigate the rate and mechanism of macrolide resistance in Yantai.
Pharyngeal swab samples were collected from adult CAP patients. Samples were assayed by polymerase chain reaction (PCR) and cultivated to test for . Nested PCR was used to specifically amplify 23S rRNA gene fragments containing mutations, and amplicons were analyzed by CE-SSCP for macrolide resistance mutations. Results were confirmed by sequencing. Twenty-seven strains of were isolated and the activities of nine antibiotics against were tested .
Out of 128 samples tested, 27 were positive for . Mycoplasma 100% macrolides resistance to . The mechanism of macrolides resistance was A2063G point mutation in the sequence directly binding to macrolides in the 23S rRNA V domain The mean pyretolytic time for the fluoroquinolone group was 4.7 ±2.9 d, which was significantly shorter than 8.2 ±4.1 d for the azithromycin group.
Macrolides are not the first-line treatment for respiratory tract infections in Yantai.
社区获得性肺炎（CAP）是一种全球性疾病，导致大量死亡，具有重大经济影响。随着诊断工具敏感性的提高，对CAP病因的认识开始发生变化。肺炎支原体是引起CAP的主要病原体之一。大环内酯类及相关抗生素是肺炎支原体感染的一线治疗药物。大环内酯类耐药已传播15年，目前在全球范围内均有发生。我们在烟台开展了关于肺炎支原体大环内酯类耐药性的首次研究。这可能有助于确定该人群中CAP的合适治疗方法。
调查烟台地区肺炎支原体大环内酯类耐药率及耐药机制。
收集成年CAP患者的咽拭子样本。通过聚合酶链反应（PCR）检测样本，并进行培养以检测肺炎支原体。采用巢式PCR特异性扩增含有突变的23S rRNA基因片段，扩增产物通过毛细管电泳-单链构象多态性分析（CE-SSCP）检测大环内酯类耐药突变。结果通过测序确认。分离出27株肺炎支原体菌株，并检测了9种抗生素对肺炎支原体的活性。
在128份检测样本中，27份肺炎支原体检测呈阳性。肺炎支原体对大环内酯类耐药率达100%。大环内酯类耐药机制为23S rRNA V结构域中与大环内酯类直接结合序列的A2063G点突变。氟喹诺酮组的平均退热时间为4.7±2.9天，明显短于阿奇霉素组的8.2±4.1天。
在烟台，大环内酯类并非肺炎支原体呼吸道感染的一线治疗药物。
