医院就诊儿童肺炎支原体感染流行病学特征及耐药情况分析

Analysis of the epidemiological features and drug resistance of Mycoplasma pneumoniae infecting pediatric inpatients

目的分析医院儿童肺炎支原体感染的流行病学及其耐药性,为临床抗感染防治提供指导。方法收集3134例儿童患者静脉血标本,从中分离血清,用呼吸道感染病原体IgM检测试剂盒检验肺炎支原体感染情况,用支原体IST检测药敏试剂盒进行药敏试验。结果 2014-2016年3 134例医院就诊患儿中946例感染肺炎支原体,阳性率30.19%,其中2014年阳性率23.06%(229/933),2015年33.18%(358/1079),2016年33.80%(359/1062)。2014-2016年的春、夏、秋、冬四季肺炎支原体阳性率分别为26.99%(220/815)、32.91%(257/781)、34.97%(270/772)和25.98%(199/766)。2014年各季肺炎支原体阳性率分别为16.85%、28.00%、27.70%和19.32%,2015年分别为33.08%、35.51%、34.56%和29.43%,2016年分别为31.16%、36.59%、40.77%和27.55%。男性患儿肺炎支原体阳性率为26.00%(513/1973),女性患儿为37.30%(433/1161),女性肺炎支原体阳性率高于男性(χ2=44.2433,P<0.05)。≤1岁患儿肺炎支原体阳性率为12.11%(192/1585),1~岁为41.33%(348/842),3~岁为52.25%(209/400),5~岁为60.12%(98/163),7~16岁为68.75%(99/144)。上呼吸道感染、支气管炎、毛细支气管炎、支气管肺炎、大叶性支气管肺炎、间质性肺炎、哮喘急性发作患儿肺炎支原体阳性率分别为29.39%(82/279)、24.00%(6/25)、19.41%(92/474)、27.32%(513/1878)、76.32%(58/76)、59.18%(29/49)和47.03%(166/353)。2014年分离的肺炎支原体对阿奇霉素、罗红霉素、克拉霉素、螺旋霉素、吉他霉素、克林霉素的耐药率分别为19.21%、17.03%、12.66%、11.35%、1.31%和0.87%,2015年分别为21.51%、17.88%、15.64%、17.88%、1.40%和0.84%,2016年分别为21.73%、17.55%、15.04%、18.38%、1.39%和1.11%。结论肺炎支原体在医院就诊患儿中的感染率逐年增高,且随着患儿年龄增长感染率增加明显;大叶性支气管肺炎儿童肺炎支原体感染率最高。肺炎支原体对大环内酯类抗生素耐药程度呈升高趋势,尤其是阿奇霉素,临床诊疗中应密切关注耐药性的发生和发展。

Objective To analyze the epidemiology and drug resistance of Mycoplasrna pneumoniae infecting pediatric inpatients in order to guide the prevention and treatment of infections in clinical settings. Methods Venous blood sam- pies were collected from 3 134 pediatric patients, and serum was separated. The prevalence of M. pneurnoniae was deter mined with a test kit to detect IgM antibodies to pathogens causing respiratory tract infections, and the drug sensitivity of M. pneumoniae was tested using an IST test kit. Results Of the 3 134 pediatric patients treated from 2014 2016, 946 were infected with M. pneumoniae. Overall, M. pneurnoniae was detected at a rate of 30. 19% （946/3,134）. M. pneumoniae was detected at a rate of 23.06% （229/933） in 2014, at a rate of 33.18% （358/1 079） in 2015, and at a rate of 33.80% （359/1062） in 2016, so the rate of detection tended to increase each year. From 2014 2016, M. pneumoniae was detected at a rate of 26.99% （220/815） in the spring, at a rate of 32.91% （257/781） in the summer, at a rate of 34.97% （270/772） in the fall, and at a rate of 25.98% （199/766） in the winter. In 2014, M. pneumoniae was detected at a rate of 16.85% in the spring, at a rate of 28.00% in the summer, at a rate of 27.70% in the fall, and at a rate of 19. 32% in the winter. In 2015, M. pneurrloniae was detected at a rate of 33.08% in the spring, at a rate of 35.51% in the summer, at a rate of 34. 56% in the fall, and at a rate of 29. 43% in the winter. In 2016, M. pneumoniae was detected at a rate of 31.16% in the spring, at a rate of 36.59% in the summer, at a rate of 40.77% in the fall, and at a rate of 27.55% in the winter. M. pneumoniae was detected in male pediatric patients at a rate of 26.00% （513/1 973） and in female pediatric patients at a rate of 37.30% （433/1 161） （ 2 =44. 2433, P〈0.05）. M. pneurnoniae was detected at a rate of 12.11% （192/1 585） in pediatric patients under 1 year of age, at a rate of 41.33% （348/842） in patients under age 3, at a rate of 52.25% （209/400） in patients under age 5, at a rate of 60.12% （98/163） in patients under age 7, and at a rate of 68.75% （99/144） in patients under age 16. M. pneurnoniae infected children with an upper respiratory tract infection at a rate of 29.39% （82/279）, it infected children with bronchitis at a rate of 24.00% （6/25）, it infected chil- dren with bronehiolitis at a rate of 19.41% （92/474）, it infected children with bronchial pneumonia at a rate of 27.32 % （513/1 878）, it infected children with lobar/bronchial pneumonia at a rate of 76.32% （58/76）, it infected children with interstitial pneumonia at a rate of 59.18% （29/49）, and it infected children with acute episodic asthma at a rate of 47. 03 % （166/353）. In 2014, the resistance of M. pneumoniae to azithromycin was 19.21%, its resistance to roxithromycin was 17.03%, its resistance to clarithromycin was 12.66%, its resistance to spiramycin was 11.35%, its resistance to kitasamycin was 1.31%, and its resistance to clindamyein was 0. 87%. In 2015, the resistance of M. pneurnoniae to az- ithromycin was 21.51%, its resistance to roxithromycin was 17.88%, its resistance to clarithromycin was 15.64%, its resistance to spiramycin was 17. 88%, its resistance to kitasamycin was 1.40%, and its resistance to clindamycin was 0. 84%. In 2016, the resistance of M. pneumoniae to azithromycin was 21. 73%, its resistance to roxithromyein was 17. 55 %, its resistance to elarithromycin was 15.04 %, its resistance to spiramycin was 18.38 %, its resistance to kitasamy- cin was 1.39%, and its resistance to clindamyein was 1.11%. Conclusion The rate at which M. pneumoniae infected pediatric inpatients tended to increase each year, and the rate of infection among pediatric patients increased with age. M. pneumoniae most often infected pediatric patients with lobar/bronchial pneumonia, so efforts to clinically combat infections should target those patients. M. pneumoniae tended to be increasingly resistant to macrolide antibiotics, and especially azithromycin, so close attention should be paid to the development and progression of drug resistance.