成人社区获得性肺炎肺炎支原体感染率和耐药率的调查

Survey on the prevalence of Mycoplasma pneumonia and macrolide resistence in adults with community-acquired-pneumonia

目的了解北京地区成人住院社区获得性肺炎（CAP）患者肺炎支原体（MP）感染、耐药情况及健康成人的MP携带率。方法入选2014年1月至2014年12月就诊于首都医科大学附属北京友谊医院呼吸内科病房的CAP患者109例及同期同科室无呼吸道症状健康医护人员18例,采集咽拭子标本进行巢氏PCR扩增和琼脂糖凝胶电泳,记录CAP患者病史、吸烟史、饮酒史、采样前是否应用喹诺酮或大环内酯类药物。结果 1住院CAP患者咽拭子标本MP阳性率为52.3%（57/109）,耐药率为57.9%（33/57）;无呼吸道症状健康医护人员MP阳性率为33.3%（6/18）,耐药率为0;住院CAP患者与无呼吸道症状健康医护人员的MP阳性率无显著差异（χ~2=2.222,P=0.136）,住院CAP患者MP耐药率明显高于无呼吸道症状健康医护人员（P=0.009）。2CAP患者MP阳性率春季高于其它季节（χ~2=15.576,P=0.001）,在性别、年龄方面无明显差异。3是否有呼吸系统基础疾病、吸烟、饮酒,采样前是否应用喹诺酮类和/或大环内酯类药物对CAP患者MP阳性率和耐药率无显著影响（所有P〉0.05）。结论成人对MP普遍易感,北京地区成人住院CAP患者MP感染率和耐药率不容忽视,合理应用抗生素至关重要。健康成人MP携带率需进一步研究。

Corresponding authors：XU Bo,E - mail：xubo ally@ 126. com;XIN De - li,E - mail：xindl48@ 126. com[Abstrct] Objective To survey the prevalence of Mycoplasma pneumoniae（MP）and macrolide resistance in adult patients with community - acquired pneumonia（CAP）and the rate of asymptomatic carriers. Methods 109 CAP patients and 18 cases of asymptomatic,healthy medical care personnel during January to De-cember in 2014 were allocated in this study. The throat swab samples were taken from all these cases and examined by nest polymers chain reac-tion. PCR products were examined by agarose gel electrophoresis. Medical history,smoking history,alcohol intake history and quinolines or mac-rolides intake history were recorded. Results 1. 57（52. 3% ）cases were positive for MP and 33 cases of CAP（57. 9% ）were resistant to mac-rolides and 6 health care persons（33. 3% ）were positive and they were sensitive to macrolides in asymptomatic,healthy adults. The difference be-tween CAP and healthy adults in prevalence of MP wasn′t statistically significant and the difference in tendency of macrolide resistance was signifi-cant（ P = 009）. 2. The prevalence of MP in CAP patients was higher in Spring than other seasons（ P = 0. 001）and the difference in sex and age was not significant. 3. The prevalence of MP and macrolide resistance didn′t show significant difference whether these patients had respiratory underlying disease,smoking,alcohol intake and antibiotic use or not. Conclusion Adults are susceptible to MP. The prevalence of MP and rate of macrolide resistance are very high in adult patients with CAP in Beijing. Further study is needed to survey the carriage of MP in healthy adult population.