Lin Lianjun, Zhang Ruixue, Zhang Zhi, Chang Yujun, Lin Rongnan, Dou Haiwei, Wang He, Wang Yuchuan, Zheng Bo
Geriatric Department, Peking University First Hospital, Beijing, People's Republic of China.
National Engineering Research Center for Beijing Biochip Technology, Beijing, People's Republic of China.
Infect Drug Resist. 2023 Jul 13;16:4593-4597. doi: 10.2147/IDR.S419873. eCollection 2023.
is an important infectious pathogen of lower respiratory tract infection in children and adolescents. Macrolide resistant (MRMP) has become increasingly prevalent, and identifying pathogen resistance genes is crucial for treatment.
We report a patient with severe refractory pneumonia (MPP). The failure of initial clinical treatment prompted the re-analysis of metagenomic next-generation sequencing (mNGS) data for macrolide-resistant gene. Macrolide-resistance 23S ribosomal RNA gene was confirmed with read depth of 64 X for the A2063G mutation, which can decrease the affinity of macrolide with ribosome resulting in macrolide resistance. Furthermore, antimicrobial susceptibility testing demonstrated that was resistant to macrolide. PCR confirmatory test about resistance A2063G mutation, clinical treatment course and prognosis with altered treatment strategy, and antimicrobial susceptibility confirmed that the severe refractory MPP was due to macrolide resistant .
As a new molecular level detection, mNGS is an effective method for detecting resistance genes. Early recognition of macrolide resistance and suitable antibiotics strategy is of vital importance for the prognosis of severe refractory MPP.
是儿童和青少年下呼吸道感染的重要传染性病原体。大环内酯耐药肺炎支原体（MRMP）日益普遍，鉴定病原体耐药基因对治疗至关重要。
我们报告一例重症难治性肺炎支原体肺炎（MPP）患者。初始临床治疗失败促使对宏基因组下一代测序（mNGS）数据重新分析以查找大环内酯耐药基因。通过对A2063G突变的64X读长深度确认了大环内酯耐药23S核糖体RNA基因，该突变可降低大环内酯与核糖体的亲和力，从而导致大环内酯耐药。此外，抗菌药敏试验表明对大环内酯耐药。关于肺炎支原体耐药A2063G突变的PCR确证试验、改变治疗策略后的临床治疗过程及预后，以及抗菌药敏结果均证实重症难治性MPP是由大环内酯耐药肺炎支原体所致。
作为一种新的分子水平检测方法，mNGS是检测肺炎支原体耐药基因的有效方法。早期识别大环内酯耐药性并采取合适的抗生素策略对重症难治性MPP的预后至关重要。
