珠海地区儿童急性下呼吸道肺炎支原体感染流行病学及肺炎支原体耐药基因检测的多中心调查与研究

Multi-center investigation and research on epidemiology of children’s acute lower respiratory tract mycoplasma pneumoniae infection and mycoplasma pneumoniae drug resistance gene detection in Zhuhai area

目的调查珠海地区儿童急性下呼吸道感染中肺炎支原体(MP)感染现状及大环内酯类耐药基因检出率,评价阿奇霉素在MP感染中的临床治疗效果。方法选取2021年3月至2022年2月珠海市妇幼保健院、珠海市人民医院、中山大学附属第五医院、珠海市中西医结合医院、遵义医科大学第五附属医院、广东省人民医院珠海医院、广东省中医院珠海医院、珠海市第五人民医院、珠海市高新区人民医院9家医院儿科门诊或住院的急性支气管炎、社区获得性肺炎患儿1178例,分析不同性别、年龄、季节及温湿度条件下MP感染情况。难治性肺炎支原体肺炎(RMPP)病例进行MP耐药基因检测。结果1178例患儿中MP感染率为24.1%(284/1178),MP感染率以10月份最高。19份耐药基因检测中94.7%(18/19)存在耐药基因位点突变。婴儿组、幼儿组、学龄前组、学龄组患儿的MP-IgM阳性率分别为6.90%、21.89%、31.95%、59.21%;男性、女性阳性率分别为19.09%、30.98%;春、夏、秋、冬四季阳性率分别为20.33%、25.33%、29.31%和21.53%;患儿年龄、性别、季节差异均有统计学意义(P<0.05)。MP感染率与月平均气温、月相对湿度均呈正相关(P<0.05)。经阿奇霉素口服或静脉注射治疗后284例MP感染患儿的治疗有效率为87.0%(247/284),平均住院时间为(6.90±0.87)d,肺部并发症发生率为2.8%(8/284)。结论调查期间珠海地区儿童MP感染率较低,秋季为感染高峰期,性别、年龄、气温、湿度等因素跟儿童MP感染有关。MP耐药基因检出率较高,但临床选用阿奇霉素口服或静脉注射进行抗感染治疗效果尚佳。

Objective To investigate the status quo of mycoplasma pneumoniae(MP)infection and the detection rate of macrolide drug resistance genes in children with acute lower respiratory tract infection in Zhuhai area,and to evaluate the clinical therapeutic efficacy of azithromycin in MP infection.Methods A total of 1178 affected children with acute bronchitis and community-acquired pneumonia admitted to or hospitalized in 9 hospitals in Zhuhai Center for Maternal and Child Health Care,Zhuhai People’s Hospital,the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine,the Fifth Affiliated Hospital of Zunyi Medical University,Guangdong Provincial People’s Hospital Zhuhai Hospital,Zhuhai Hospital of Guangdong Provincial Hospital of Chinese Medicine,the Fifth People’s Hospital of Zhuhai,and Zhuhai High-tech Zone People’s Hospital from March 2021 to February 2022 were selected,and their situation of MP infection under different genders,ages,seasons,and temperature and humidity conditions were analyzed.The MP drug resistance genes were detected in patients with refractory mycoplasma pneumoniae pneumonia(RMPP).Results The infection rate of MP in 1178 affected children was 24.1%(284/1178),with the highest infection rate in October.In drug resistance gene detection of 19 cases,94.7%(18/19)were found to have mutations in drug resistance gene sites.The positive rates of MP-IgM in the infant group,the toddler group,the pre-school group,and the school-age group were 6.90%,21.89%,31.95%,and 59.21%,respectively;The positive rates for males and females were 19.09%and 30.98%,respectively;The positive rates in spring,summer,autumn,and winter were 20.33%,25.33%,29.31%,and 21.53%,respectively.There were statistically significant differences in ages,genders,and seasons in the affected children(P<0.05).The infection rates of MP were all positively correlated with monthly average temperature and monthly relative humidity(P<0.05).After oral or intravenous treatment with azithromycin,the effective rate of treatment for 284 affected children with MP infection was 87.0%(247/284).The average hospitalization time was(6.90±0.87)days,and the incidence of pulmonary complications was 2.8%(8/284).Conclusion During the investigation,the MP infection rate of children in Zhuhai area is relatively low,and the peak of infection is in autumn.Factors such as gender,age,temperature and humidity are related to MP infection of children.The detection rate of MP drug resistance genes is relatively high,but the clinical oral administration or intravenous injection of azithromycin is still effective in anti-infection treatment.