儿童肺炎支原体感染流行病学特征分析

Epidemiological characteristics of Mycoplasma pneumoniae infection in children

目的探讨浙江地区儿童肺炎支原体(MP)感染流行病学特征和临床特点。方法收集2021-2022年本院临床表现为发热、鼻塞、咳嗽、呼吸困难、扁桃体炎和肺炎的患儿作为研究对象。采集并培养MP阳性标本。采用倍比稀释法测定MP对红霉素、乙酰螺旋霉素、罗红霉素、阿奇霉素、克拉霉素、环丙沙星和司帕沙星耐受程度。对MP-23S rRNA V区进行PCR扩增,并测序。结果MP阳性样本215份,阳性率20.73%;其中2021年检出98份MP阳性标本,阳性率19.48%;2022年117份MP阳性阳性本,阳性率21.91%。支气管炎中MP阳性率17.33%(13/75),支气管肺炎中MP阳性率20.97%(134/639),大叶性肺炎中MP阳性率22.93%(36/157),重症肺炎中MP阳性率26.56%(17/64)。MP春季、夏季、秋季和冬季检出率分别为:22.09%(36/163)、19.23%(15/78)、16.27%(55/338)和21.62%(99/458)。<6个月、6个月~、1~岁、3~岁、5~14岁各年龄组阳性率分别为:19.89%(36/181)、24.47%(58/237)、20.81%(67/322)、19.70%(40/203)和13.83%(13/94)。MP对红霉素、乙酰螺旋霉素、罗红霉素、阿奇霉素、克拉霉素、环丙沙星和司帕沙星耐药率分别为:58.60%、62.79%、45.58%、52.09%、37.67%、4.19%和0.47%。选取的60株MP菌株中共有46株发生位点突变,22株发生A2063G,17株发生A2064G,3株发生G2062A,2株发生A2063T,1株发生A2063C和1株C2617G。结论MP感染男童多于女童,全年皆有病例,秋冬季高发。MP对红霉素、乙酰螺旋霉素和阿奇霉素耐药率较高,这与MP-23S rRNA V区突变有关。

Objective The epidemiological and clinical characteristics of Mycoplasma pneumoniae infection were explored in children in Zhejiang region.Methods Children who were hospitalized in our hospital from 2021 To 2022 and whose clinical manifestations were fever,stuffy nose,cough,dyspnea,tonsillitis and pneumonia were collected as research objects.The MP positive specimens were collected and cultivated.The tolerance of MP to Erythromycin,acetyl Spiramycin,Roxithromycin,Azithromycin,Clarithromycin,Ciprofloxacin and sparfloxacin was determined by double dilution method.The MP-23S rRNA V region were amplified by PCR and then were sequenced.Results 215 MP positive samples,with a positive rate of 20.73%.Among them,98 MP positive specimens were detected in 2021,with a positive rate of 19.48%;In 2022,there were 117 MP positive cases,with a positive rate of 21.91%.MP positive rate was 17.33%(13/75)in bronchitis,20.97%(134/639)in bronchopneumonia,22.93%(36/157)in lobar pneumonia,and 26.56%(17/64)in severe pneumonia.The detection rates of MP in spring,summer,autumn,and winter were 22.09%(36/163),19.23%(15/78),16.27%(55/338),and 21.62%(99/458),respectively.The positive rates for the age groups of 6 months,6 months-old,1-year old,3-year old,and 5-14 year old were 19.89%(36/181),24.47%(58/237),20.81%(67/322),19.70%(40/203),and 13.83%(13/94),respectively.The resistance rates of MP to erythromycin,acetyl spiramycin,roxithromycin,azithromycin,clarithromycin,ciprofloxacin and sparfloxacin were 58.60%,62.79%,45.58%,52.09%,37.67%,4.19%and 0.47%,respectively.There 46 strains of 60 strains MP selected were mutated,including 22 mutations were A2063G,17 mutations were A2064G,3 mutations were G2062A,2 mutations were A2063T,1 mutations were A2063C and 1 mutations were C2617G.Conclusion More boys than girls have cases throughout the year,with a high incidence in autumn and winter.MP had a high resistance rate to erythromycin,acetylspiramycin and azithromycin,which was related to the mutation of MP-23S rRNA V region.