儿童肺炎支原体肺炎耐药情况及阿奇霉素临床疗效观察

Drug Resistance Situation and Clinical Efficiency of Azithromycin in Children with Mycoplasma Pneumoniae Pneumonia

目的:了解儿童肺炎支原体肺炎(MPP)对大环内酯类抗生素的耐药情况,观察阿奇霉素治疗耐药MPP的临床疗效。方法:于2012年10月至2014年3月采集儿科病房疑似MPP患儿咽拭子标本共100例,应用巢式PCR扩增及DNA测序检测红霉素作用靶位23SrRNA基因。在此基础上将患儿分为敏感组(MS-MPP组)及耐药组(MR-MPP组),比较两组患儿对阿奇霉素治疗反应的差异。结果:经PCR扩增,100例咽拭子标本中91例阳性,26例无点突变,65例存在点突变,其中58例为2063位A→G点突变,7例为2064位A→G点突变,耐药率71.4%。32例MR-MPP患儿与17例MS-MPP患儿比较,阿奇霉素治疗后MS-MPP组发热时间、总热程、住院时间均短于MR-MPP组,差异有统计学意义(P<0.05)。结论:儿童MPP耐药情况严重,对阿奇霉素治疗反应性降低,发热时间、总热程、住院时间延长。

Objective： To observe the drug resistance situation to macrolide antibiotics and the clinical efficiency of azithromycin in children with Mycoplasma pneumoniae pneumonia（ MPP）. Methods： One hundred throat swab specimens were collected from 100 inpatient children suspected with MPP from October 2012 to March 2014,and erythromycin target site 23 SrRNA gene were determined by nested PCR and DNA sequencing. Children were divided into two groups： sensitivity group（ MS-MPP group） and drug-resistant group（ MR-MPP group）,azithromycin efficiency were compared between two groups. Results： Ninety one of 100 specimens were positive by nested PCR. DNA sequencing showed 26 cases had no mutation in 23 SrRNA,65 cases had point mutation,among them 58 cases had A→G mutation at 2063,7 cases had A→G mutation at 2064. The drug resistance rate was 71.4%. Thirty-two cases in MRMPP group and 17 cases in MS-MPP group showed significant differences in fever time,total febrile days,length of hospital stay after azithromycin therapy（ P0.05）. Conclusion： Drug resistance situation was severe in children with MPP,fever tome,total febrile days and length of stay were longer after azithromycin therapy.