| 摘要: |
| 目的：探讨不规律使用大环内酯类抗生素与肺炎支原体（MP）耐药的相关性及规律使用阿奇霉素序贯疗法治疗儿童支原体肺炎（MPP）的有效性。方法：选取431例MP感染患儿，根据患儿MP感染次数分为观察组217例和对照组214例，观察组咽拭子标本培养结果阳性且对阿奇霉素敏感者与对照组培养结果阳性且对阿奇霉素耐药者提取DNA进行23s rRNA V区基因突变位点检测，对细菌培养阳性者进行药敏试验，根据药敏试验结果选择观察组中对大环内酯类抗菌药物敏感及23s rRNA V区无突变的患儿进行阿奇霉素序贯治疗，观察治疗效果。结果：观察组与对照组患儿MP培养阳性者分别为56例和49例，两组MP对大环内酯类药物耐药率为19.6% vs 75.5%，差异有统计学意义（χ2=32.868，P<0.01）。对照组患儿不规范使用大环内酯类药物次数与肺炎支原体耐药率呈正相关（χ2=22.056，P<0.01；r=0.321，P<0.01）。观察组对阿奇霉素敏感且23s rRNA V区基因位点无突变的26例患儿行阿奇霉素序贯治疗2２周和4周时ＭＰ培养阴性率分别为73.1%和92.3%，基因测序结果显示培
养阳性菌株仍未发现23s rRNA V区基因位点突变。结论：不规律应用大环内酯类抗生素可增加ＭＰ耐药率，MP耐药性与23s rRNA V区基因位点突变有关；对儿童MP感染在没有药敏结果情况下，规律使用阿奇霉素抗感染治疗，不会诱导耐药菌株出现。 |
| 关键词: 肺炎支原体 耐药 大环内酯类抗生素 阿奇霉素 序贯治疗 基因位点 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2017.07.013 |
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| 基金项目:：甘肃省高等学校科学研究项目，编号2015B-138 |
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| Association Study of Drug Resistance of Mycoplasma Pneumoniae Pneumonia and the Application of Macrolides Antibiotics in Children |
| Ma Hongxia1, Zhou tian1, Wei Guoye1, Wang Ying1, Liu Hua1, Lian Xiyuan2 |
| (1.Jingbian People’s Hospital, Shaanxi Jingbian 718500, China; 2. Pingliang People’s Hospital, Gansu Pingliang 744000, China)) |
| Abstract: |
| Objective: To discussthe relation between irregular use of macrolides antibiotics and mycoplasma pneumonia (MP) resistance, and infer efficacy of regular sequential use of azithromycin for the treatment of mycoplasma pneumoniae pneumonia (MPP) in children. Methods: 431 MP infected children of Jan.2013 to Mar. 2015 were selected, and were divided into observer group (217 cases) and control group (214 cases) according to MP infection times during past year, DNA was extracted from the observer cases with specimens cultivate positive result and sensitive to azithromycin,also from the control cases with specimens cultivate positive result and resistant to azithromycin, and to examine gene mutations of 23 s rRNA, drug sensitive test was conducted for those strains with culture positive and cases in observer group with sensitive to macrolides antibiotics and with no 23s rRMA V zone mutations were selected and applicated with azithromycin sequential therapy and to observe clincal efficacy. Results: MP cultural positive cases for observer and control group were 56 and 49 cases respectively, two groups with resistant ratio to macrolides antibiotics (19.6% vs 75.5 %) with significant difference (χ2=32.868, P<0.001). In control group, there was positive correlation between irregular using times of macrolides antibiotics and drug resistant ratio (χ2=22.056, P<0.001; r=0.321, P<0.001). 26 children in observer group with sensitive to azithromycin and with no 23s rRNA V zone gene locus mutation whose MP cultural negative rate were 73.1% and 92.3% respectively after azithromycin sequential therapy for 2 weeks and 4 weeks, gene sequencing results showed that cultural positive strains had still not found 23s rRNA V zone gene locus mutation.Conclusion: Irregular use of macrolides antibiotics can increase the MP resistance ratio, which is correlated with 23s rRNA V zone gene locus mutation. Under circumstances of no MP drug susceptibility results, regular use of azithromycin for anti-infection treatment, would not induce resistant strains. |
| Key words: pneumonia mycoplasma drug resistance macrolides antibiotics azithromycin sequential therapy gene locus |
