肺炎支原体的感染治疗及对大环内酯类药物的耐药现状和机制

Treatment of Mycoplasma pneumoniae infection and status and mechanism of macrolide resistance

肺炎支原体(Mycoplasma pneumoniae,Mp)是导致社区获得性肺炎的重要病原体。大环内酯类药物是治疗肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)的首选用药,对大环内酯类药物耐药的肺炎支原体(macrolide-resistantMycoplasma pneumoniae,MRMP)引起的肺炎将考虑使用二线四环素类或喹诺酮类药物。MRMP的检出率在世界范围内急剧增加。来自国内外的数据表明,MRMP在亚洲地区如日本、中国、韩国等高度流行。Mp耐药机制主要是23S rRNAⅤ区A2063G位点的突变,此外核糖体蛋白L4和L22基因突变、核糖体甲基化修饰以及外排泵的形成也是其耐药机制。本文系统归纳MPP治疗、Mp对大环内酯类药物耐药的流行病学及其机制的研究进展。

Mycoplasma pneumoniae(Mp)is an important pathogen causing community-acquired pneumonia.Macrolide is the first choice for the treatment of Mycoplasma pneumoniae pneumonia(MPP),while second-line drugs like tetracyclines or quinolones will be considered for pneumonia caused by macrolide-resistant Mycoplasma pneumoniae(MRMP).The isolation rate of MRMP has increased dramatically worldwide.Data from domestic and abroad indicate that MRMP is highly prevalent in Asian regions such as Japan,China,and Korea.The main mechanism of drug resistance in Mp is mutation A2063G of 23S rRNA V.In addition,mutations in the ribosomal protein L4 and L22 genes,ribosomal methylation modifications and the formation of efflux pumps are also significant drug resistance mechanisms.In this study,we summarize the treatment of MPP,the epidemiology of MRMP and the research progress of its mechanisms systematically.