Department of pharmacy, Karamay central hospital of Xinjiang, Karamay, Xinjiang, China.
Department of emergency, Karamay central hospital of Xinjiang, Karamay, Xinjiang, China.
J Antimicrob Chemother. 2022 Aug 25;77(9):2353-2363. doi: 10.1093/jac/dkac170.
To determine the prevalence of resistance to macrolides in Mycoplasma pneumoniae worldwide.
Prior to 12 December 2020, PubMed, Web of Science, Scopus and Embase databases were searched for epidemiological studies of M. pneumoniae resistance. Two reviewers independently extracted data from included studies. The extracted data include sampling population, total sampling number, the number of resistant strains and the molecular subtype of resistant strains. The estimate of resistance prevalence was calculated using the random-effects model.
A total of 17 873 strains were obtained from five continents and reported in 98 investigations between 2000 and 2020, with 8836 strains characterized as macrolide resistant. In summary, macrolide-resistant M. pneumoniae was most common in Asia (63% [95% CI 56, 69]). In Europe, North America, South America and Oceania, the prevalence was 3% [2, 7], 8.6% [6, 11], 0% and 3.3%, respectively. Over the last 20 years, the prevalence of macrolide-resistant M. pneumoniae has remained high in China (81% [73, 87]), with a significant increasing trend in South Korea (4% [1, 9] to 78% [49, 93], P < 0.0001). Furthermore, a point mutation at 2063 from A to G was mostly related to M. pneumoniae macrolide resistance. In terms of clinical outcomes, longer cough (mean difference [MD]: 2.93 [0.26, 5.60]) and febrile days (MD: 1.52 [1.12, 1.92]), and prolonged hospital stays (MD: 0.76 [0.05, 1.46]) might be induced by macrolide-resistant M. pneumoniae pneumonia.
The incidence of macrolide-resistant M. pneumoniae varies globally, with eastern Asia having a greater degree of resistance. However, attention is also required in other areas, and antibiotic alternatives should be considered for treatment in high-prevalence countries.
确定全球肺炎支原体对大环内酯类药物耐药的流行率。
截至 2020 年 12 月 12 日，检索 PubMed、Web of Science、Scopus 和 Embase 数据库中关于肺炎支原体耐药性的流行病学研究。两位评审员独立从纳入的研究中提取数据。提取的数据包括采样人群、总采样数量、耐药株数量和耐药株的分子亚型。使用随机效应模型计算耐药流行率的估计值。
从 2000 年至 2020 年，从五大洲的 98 项研究中获得了 17873 株菌株，其中 8836 株被确定为大环内酯类耐药。总的来说，亚洲的肺炎支原体大环内酯类耐药最为常见（63%[95%CI 56，69]）。在欧洲、北美、南美和大洋洲，流行率分别为 3%[2，7]、8.6%[6，11]、0%和 3.3%。在过去的 20 年中，中国肺炎支原体大环内酯类耐药的流行率一直很高（81%[73，87]），韩国的耐药率呈显著上升趋势（4%[1，9]至 78%[49，93]，P<0.0001）。此外，A 到 G 的 2063 点突变与肺炎支原体对大环内酯类药物的耐药性最为相关。在临床结局方面，大环内酯类耐药肺炎支原体可能导致更长的咳嗽（平均差异[MD]：2.93[0.26，5.60]）和发热天数（MD：1.52[1.12，1.92]），以及更长的住院时间（MD：0.76[0.05，1.46]）。
全球肺炎支原体对大环内酯类药物的耐药率存在差异，东亚地区的耐药率更高。然而，其他地区也需要引起重视，在高耐药率国家应考虑抗生素替代治疗。
