儿童肺炎支原体的耐药性与临床药物治疗预后的相关性研究

Relationship between drug resistance and prognosis of children with Mycoplasma pneumonia clinical after drug treatment

目的探讨儿童肺炎支原体（MP）的耐药性与临床药物治疗预后的相关性。方法选择2013年8月～2016年2月河北省儿童医院呼吸科诊治的合并发热和/或咳嗽的社区获得性肺炎患儿360例,将其分为对照组（n=160,1年内反复MP感染且不规律应用大环内酯类抗菌药物≥2次）和观察组（n=200,半年内无MP感染和无大环内酯类抗菌药物应用史）,两组都进行MP的培养与耐药分析,同时都给予阿奇霉素治疗,观察预后情况。结果观察组与对照组的MP阳性率分别为19.5%和41.9%,观察组明显低于对照组（P〈0.05）。MP培养结果呈阳性患儿中对红霉素、阿奇霉素、罗红霉素、克拉霉素、加替沙星的耐药率分别为61.3%、20.8%、76.4%、50.9%和0.9%。其中观察组与对照组对于阿奇霉素的耐药率分别为10.3%和26.9%,观察组明显低于对照组（P〈0.05）。治疗后观察组与对照组的有效率分别为96.0%和81.3%,观察组明显高于对照组（P〈0.05）;观察组的平均住院时间与发热时间为（7.01±2.13）、（5.14±1.78）d,均明显少于对照组[（9.82±1.78）、（8.53±1.92）d],差异均有统计意义（P〈0.05）。结论 MP反复感染且不规律应用大环内酯类抗菌药物可导致社区获得性肺炎患儿的MP阳性率增加,对阿奇霉素的耐药率也较高,从而导致病程延长及治疗效果降低。

Objective To investigate the relationship between drug resistance and prognosis of clinical drug treatment in children with Mycoplasma pneumoniae（MP）. Methods From August 2013 to February 2016, 360 children with community acquired pneumonia and combined with fever and/or cough in Department of Respiratory of Hebei Children＇s Hospital were selected, they were divided into the control group（n = 160, 1 years repeated MP infection and irregular application of macrocyclic lactone antimicrobial drugs no less than 2 times per year） and observation group（n = 200, without MP infection or application history of macrocyclic lactone antibiotics within half a year）. Children of the two groups were given the cultivation and resistance analysis of MP, and the treatment of Azithromycin, the prognosis were observed. Results The positive rate of MP in the observation group and control group were 19.5% and 41.9% respectively, the observation group was significantly lower than that of the control group（P〈 0.05）. The resistance rates of erythromycin, azithromycin, roxithromycin, clarithromycin, gatifloxacin of children with MP infection were 61.3%, 20.8%,76.4%, 50.9% and 0.9% respectively. The Azithromycin resistant rates in the observation group and the control group were 10.3% and 26.9% respectively, the observation group was lower than that of the control group（P〈 0.05）. After treatment, effective rates of the observation group and the control group were 96.0% and 81.3% respectively, the observation group was higher than that of control group（P〈 0.05）; the average hospitalization time and fever time in the observation group were（7.01±213） d and（5.14±1.78） d, were less than the control group [（9.82±1.78）,（8.53±1.92） d]（P〈 0.05）. Conclusion Repeated infection of MP and irregular application of macrocyclic lactone antimicrobial drug can increase the positive rate of MP and Azithromycin resistance rate for children with community acquired pneumonia,thus lead to the course prolongation and poor therapeutic effect.