2016年至2019年北京住院儿童肺炎支原体感染流行病学特征和耐药性

Epidemiological characteristics and macrolide-resistance of children hospitalized with Mycoplasma pneumo-niae infection in Beijing from 2016 to 2019

目的研究2016年至2019年北京地区住院儿童肺炎支原体(MP)感染流行病学特征和耐药性,以期为儿童肺炎支原体肺炎(MPP)的防治提供依据。方法回顾性分析2016年1月至2019年9月在北京儿童医院住院治疗的8691例社区获得性肺炎患儿的临床资料,采用实时荧光核酸恒温扩增检测技术(SAT)试剂盒检测MP感染情况,采用MP核酸及耐药突变位点检测试剂盒(荧光PCR法)检测MP耐药情况。计数资料采用χ^(2)检验进行分析。结果8691例行SAT检测的患儿中,MP总检出率为28.10%(2442/8691例)。2016年至2019年MP检出率分别为26.23%、31.36%、27.84%、26.57%,2017年检出率明显高于其他年份(χ^(2)=16.11,P<0.05)。女性患儿MP检出率为29.65%(1107/3733例),明显高于男性患儿的26.93%(1335/4958例)(χ^(2)=7.85,P<0.05)。夏秋季MP检出率分别为32.21%(726/2254例)、39.76%(852/2143例),明显高于春冬季的17.00%(327/1924例)、22.66%(537/2370例)(χ^(2)=315.15,P<0.001)。学龄前期和学龄期MP检出率分别为35.06%(732/2088例)、37.71%(1160/3076例),明显高于婴儿期和幼儿期[11.20%(232/2072例)、22.01%(318/1445例)](χ^(2)=509.89,P<0.001)。1524例行荧光PCR耐药基因检测的患儿中,1386例发生耐药基因突变,耐药率为90.94%。2016年至2019年MP耐药率分别为88.19%、90.93%、90.56%和92.90%。MP耐药率不受性别、年龄和季节的影响。结论MP四季均可检出,以夏秋季检出率最高;女性患儿检出率高于男性患儿;MP检出率随年龄的增加逐渐升高,学龄前期和学龄期检出率较高;MP耐药率居高不降。

Objective To investigate epidemiological characteristics and macrolide-resistance of hospitalized children with Mycoplasma pneumoniae(MP)infections in Beijing from 2016 to 2019,so as to provide basis for the prevention and treatment of pediatric Mycoplasma pneumoniae pneumonia(MPP).Methods The clinical data were analyzed retrospectively from 8691 children hospitalized with community acquired pneumonia in Beijing Children′s Hospital between January 2016 and September 2019.MP RNA was detected by simultaneous amplification and testing(SAT),and macrolide resistance of MP was examined by MP and macrolide-resistant isolate diagnostic kit(PCR with fluorescence probes).Chi-square test was used for categorical analysis.Results Among 8691 cases detected by SAT,the overall detection rate of MP was 28.10%(2442/8691 cases).The detection rates of MP from 2016 to 2019 were 26.23%,31.36%,27.84%and 26.57%,respectively.The detection rate of MP in 2017 was significantly higher than that in other years(χ^(2)=16.11,P<0.05).The detection rate of MP in females was 29.65%(1107/3733 cases),which was evidently higher than that in males 26.93%(1335/4958 cases)(χ^(2)=7.85,P<0.05).The positive rates of MP in summer[32.21%(726/2254 cases)]and autumn[39.76%(852/2143 cases)]were significantly higher than those in spring[17.00%(327/1924 cases)]and winter[22.66%(537/2370 cases)](χ^(2)=315.15,P<0.001).The percentages of MP were 35.06%(732/2088 cases)in preschoolers and 37.71%(1160/3076 cases)in school-age children,which were significantly higher than 11.20%(232/2072 cases)in infants and 22.01%(318/1445 cases)in toddlers(χ^(2)=509.89,P<0.001).Macrolide resistance detection was conducted in 1524 patients by fluorescent PCR.Among them,1386 patients were positive for drug resistance,and the positive rate was 90.94%.The prevalence of macrolide-resistant MP from 2016 to 2019 were 88.19%,90.93%,90.56%and 92.90%,respectively.Macrolide-resistant rates were not related with gender,age and season.Conclusions MP can be detected in all seasons,but most prevalently in summer and autumn.Girls are more prone to MP infections than boys.The detection rate of MP increases with age,and the positive rate is higher in preschoolers and school-age children.During the 4-year study period,the drug resistant rate of MP remain high.