梅州地区2010-2014年儿童肺炎支原体感染及耐药情况分析

Mycoplasma pneumoniae infection and drug resistance in children in Meizhou area from 2010 to 2014

目的了解儿童社区获得性肺炎患者肺炎支原体感染及药敏情况,为临床诊断和治疗提供有力依据。方法对2010年1月到2014年12月期间梅州地区3家医院儿科门诊及住院部治疗的5 076例社区获得性肺炎患儿进行咽拭子肺炎支原体培养,并检测对红霉素、罗红霉素、阿奇霉索、乙酰螺旋霉素、克林霉素和克拉霉素6种药物的敏感性。结果对肺炎支原体培养的结果表明,肺炎支原体阳性者1 782例,总阳性率为35.11%,其中2012年感染率最高达43.68%,为流行高峰期。季节分布方面,一年四季均可发病,春夏季节感染率高于秋冬季节,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（35.91%）高于男性（34.36%）,但差异无统计学意义。患儿年龄方面,1~3岁组感染率最高为42.42%,6-12岁组感染率最低为16.49%,且各年龄组间阳性率差异有统计学意义（P〈0.05）。药敏实验结果显示,红霉素、罗红霉素、阿奇霉索、乙酰螺旋霉素、克林霉素和克拉霉素的敏感率分别为41.98%（748/1 782）、55.22%（984/1 782）、66.84%（1 191/1 782）、69.25%（1 234/1 782）、67.79%（1 208/1 782）和59.32%（1 057/1 782）。其中红霉素、罗红霉素、阿奇霉索和乙酰螺旋霉素2010—2014年的敏感率呈现明显的逐年下降趋势,这4种药物不同年份敏感率之间的差异有统计学意义（均P〈0.05）。克林霉素2010—2014年敏感率波动不明显,克拉霉素虽然也呈现逐年下降的趋势但幅度不大,这两种药物不同年份敏感率之间的差异没有统计学意义（均P〉0.05）。结论社区获得性肺炎患儿中肺炎支原体感染率较高,婴幼儿期发病率较高,易发于春夏季节。对社区获得性肺炎患儿应尽早进行肺炎支原体培养及药敏检测,使患儿得到及时正确的治疗,减少耐药株的出现。

In order to survey the Mycoplasma pneumoniae（Mp）infection and drug resistance in children with Community Acquired Pneumonia（CAP）to provide a rational basis for the clinical diagnosis and treatment of Mpinfection,a total of 5 076 throat swabs were collected from children with CAP,who visited the pediatric outpatient department or received treatment in the pediatric ward of three hospitals in Meizhou area from January 2010 to December 2014.The swabs were cultured to detect Mp.The drug sensitivity of Mpto erythromycin,roxithromycin,azithromycin,acetylspiramycin,clindamycin and clarithromycin was evaluated.According to the result of the cultivation of Mp,1 782（35.11%）were Mp-positive.The year of 2012 was the epidemic peak,the infection of Mprate was up to 43.68%.There were cases of Mpinfection in all four seasons of the year but infection rates in spring and summer were significantly higher than those in autumn and winter（P〈0.05）.The infection rate in females was higher than that in males（35.91% vs 34.36%;P〉0.05）.For the age of the sick children,the infection rate for the age group of younger than 3years old was the highest as 42.42%.The age group of younger than 12 years old was the lowest as only 16.49%,and there were significant differences in the infection rate among all age groups（P〈0.05）.According to the results of drug sensitive test,the sensitive rate of erythromycin,roxithromycin,azithromycin,acetylspiramycin,clindamycin and clarithromycin was 41.98%（748/1 782）,55.22%（984/1 782）,66.84%（1 191/1 782）,69.25%（1 234/1 782）,67.79%（1 208/1 782）and 59.32%（1 057/1 782）,respectively.The sensitive rate of erythromycin,roxithromycin,azithromycin and acetylspiramycin significantly declined year by year from 2010 to 2014,the differences of their sensitive rate between different years were statistically significance（all P〈0.05）.The sensitive rate of fluctuations of clindamycin was not obvious and the sensitive rate of clarithromycin had dropped year by year slightly from 2010 to 2014,the differences of their sensitive rate between different years were no statistically significance（all P〉0.05）.In conclusion,Mpinfection rate was very high among children with respiratory tract infection.The incidence of Mpinfection was relatively high among infants and young children and children are more susceptible to Mpinfection in spring and summer than those in autumn and winter.Throat swabs should be cultured and drug sensitivity tests should be performed as early as possible in children with CAP,so that proper intervention can be undertaken in time to reduce drug-resistant strains of Mp.