中国住院儿童支原体肺炎的临床特征及抗生素耐药性

Clinical Characteristics and Antibiotic Resistance of Mycoplasma Pneumoniae Pneumonia in Hospitalized Chinese Children.

作者信息

Yuan Chen, Min Fang-Mei, Ling Yin-Jie, Li Gang, Ye Hong-Zhou, Pan Jia-Hui, Wang Ling, Xie Yan-Ping

机构信息

Department of Pediatrics, The First Hospital of Huzhou, First Affiliated Hospital of Huzhou University, No. 158 Guangchanghou Road, Huzhou, Zhejiang 313000, China.

Department of Respiration, The First Hospital of Huzhou, First Affiliated Hospital of Huzhou University, No. 158 Guangchanghou Road, Huzhou, Zhejiang 313000, China.

出版信息

Comb Chem High Throughput Screen. 2018;21(10):749-754. doi: 10.2174/1386207322666190111112946.

DOI:10.2174/1386207322666190111112946

PMID:30636596

Abstract

AIM

To analyze the clinical characteristics and antibiotic resistance of Mycoplasma pneumoniae pneumonia (MP) in Chinese patients, providing valuable information for the management of patients with MP.

METHODS

A total of 120 children who were hospitalized in The First Hospital of Huzhou between January and December 2016 for respiratory tract infection due to M. pneumoniae were enrolled in this study. Infection with M. pneumoniae was confirmed by ELISA for M. pneumoniae antibody, PCR, and throat culture. Antibiotic resistance was measured from the minimum inhibitory concentrations (MICs) of antibiotics. The 23S rRNA gene of M. pneumoniae was also examined for mutations using DNA sequencing. Patients with MP were classified into antibiotic resistance (n = 98) and no resistance (n = 20) groups. For the 98 patients showing antibiotic resistance, they were further stratified into subgroups based on the antibiotics initially prescribed: azithromycin or erythromycin (n = 78) and cephalosporin or penicillin (n = 20). Clinical characteristics were compared between the patient groups.

RESULTS

Antibiotic resistance group presented significantly longer febrile days compared to the no resistance group (P = 0.007). The number of febrile days after macrolide treatment was also longer in antibiotic resistance group than in no resistance group (P = 0.042). MP patients initially treated with azithromycin or erythromycin showed a longer average duration of respiratory symptoms (P = 0.046) and had a fever for more days after macrolide treatment (P = 0.009) compared to those received cephalosporin or penicillin. The average white blood cell count of patients treated with azithromycin or erythromycin was nearly half of those treated with cephalosporin or penicillin (P < 0.001). Nearly 90% of the resistant M. pneumoniae strains showed A to G substitution at position 2063 of the 23S rRNA gene.

CONCLUSION

The clinical characteristics and antibiotic resistance of MP were analyzed in 120 Chinese patients. DNA sequencing revealed a highly prevalent A2063G mutation in the 23S rRNA gene.

摘要

目的

分析中国患者肺炎支原体肺炎（MP）的临床特征及抗生素耐药性，为MP患者的管理提供有价值的信息。

方法

选取2016年1月至12月在湖州市第一医院因肺炎支原体呼吸道感染住院的120例儿童纳入本研究。通过肺炎支原体抗体ELISA、PCR及咽拭子培养确诊肺炎支原体感染。通过抗生素最低抑菌浓度（MIC）测定抗生素耐药性。采用DNA测序检测肺炎支原体23S rRNA基因的突变情况。将MP患者分为抗生素耐药组（n = 98）和非耐药组（n = 20）。对于98例显示抗生素耐药的患者，根据最初开具的抗生素进一步分层为亚组：阿奇霉素或红霉素组（n = 78）和头孢菌素或青霉素组（n = 20）。比较各患者组的临床特征。

结果

抗生素耐药组的发热天数明显长于非耐药组（P = 0.007）。抗生素耐药组大环内酯类治疗后的发热天数也长于非耐药组（P = 0.042）。与接受头孢菌素或青霉素治疗的患者相比，最初接受阿奇霉素或红霉素治疗的MP患者呼吸道症状平均持续时间更长（P = 0.046），大环内酯类治疗后发热天数更多（P = 0.009）。接受阿奇霉素或红霉素治疗患者的平均白细胞计数几乎是接受头孢菌素或青霉素治疗患者的一半（P < 0.001）。近90%的耐药肺炎支原体菌株在23S rRNA基因的2063位出现A到G的替换。