1026例儿童肺炎支原体感染及耐药情况分析

Mycoplasma pneumoniae infection and drug resistance in children: an analysis of 1026 cases

目的了解儿童呼吸道感染患者肺炎支原体感染及耐药情况,为临床诊断和治疗提供有力依据。方法对2010年9月到2011年9月于我院儿科门诊就诊和儿科病房住院的3529例呼吸道感染患儿进行咽拭子肺炎支原体培养,并检测对阿奇霉素、罗红霉素、红霉素、乙酰螺旋霉素、克拉霉素的药物敏感性。结果在3529例患儿中,肺炎支原体培养阳性者1026例,总阳性率为29.07%。季节分布方面,一年四季均有不同程度肺炎支原体感染病例,夏秋季节感染率高于冬春季,季节间阳性率差异有统计学意义(P<0.05)。性别方面,女性阳性率(30.43%)高于男性(28.32%),但差异无统计学意义。随患儿年龄增大,阳性率逐渐下降,且各年龄组间阳性率差异有统计学意义(P<0.05)。药敏试验结果显示,适宜儿童使用的大环内酯类抗生素耐药性由高到低依次为罗红霉素、红霉素、乙酰螺旋霉素、克拉霉素和阿奇霉素。肺炎支原体培养阳性菌株对5种抗生素的耐药情况差异有统计学意义(P<0.01)。结论呼吸道感染患儿中肺炎支原体感染率较高,学龄期儿童发病率较低,易发季节为夏秋季。对呼吸道感染的患儿应尽早进行肺炎支原体咽拭子培养及药敏检测,使患儿得到及时正确的治疗,减少耐药株出现。

Objective To investigate the Mycoplasma pneumoniae （MP） infection and drug resistance in children with respiratory tract infection and to provide a rational basis for the clinical diagnosis and treatment of MP infection. Methods Throat swabs were collected from 3529 children with respiratory tract infection, who visited the pediatric outpatient department or received treatment in the pediatric ward of our hospital from September 2010 to September 2011. The swabs were cultured to detect MP. The drug sensitivity of MP to azithromycin, roxithromycin, erythromyein, acetylspiramycin and clarithromycin was evaluated. Results Of the 3529 children with respiratory tract infection, 1026 （29.07%） were MP-positive. There were cases of MP infection in all four seasons of the year but infection rates in summer and autumn were significantly higher than in spring and winter （P 〈 0.05 ）. The infection rate in females was higher than in males （30.43% vs 28.32% ; P 〉0.05 ）. The infection rate was negatively correlated with age in these children, and there were significant differences in the infection rate among all age groups （ P 〈 0. 05 ）. For macrolide antibiotics suitable for children, the cultured MP developed the highest resistance to roxithromycin, followed by erythromycin, acetylspiramycin, clarithromycin, and azithromycin, with significant differences among them （P 〈 0.01 ）. Conclusions MP infection rate is very high among children with respiratory tract infection. The incidence of MP infection is relatively low among school-age children and children are more susceptible to MP infection in summer and autumn than in spring and winter. Throat swabs should be cultured and drug sensitivity tests should be performed as early as possible in children with respiratory tract infection, so that proper intervention can be undertaken in time to reduce drug-resistant strains of MP.