目的 了解2015-2016年北京地区儿童肺炎支原体(MP)耐药情况及耐药机制分析。方法 采集2015-2016年首都医科大学附属北京朝阳医院儿科收治的,具有发热、咳嗽或咽痛等呼吸道感染症状之一的,门诊和住院的89例患儿的呼吸道咽拭子标本,进行MP 培养与药敏试验,采用巢式PCR扩增法鉴定MP 耐药位点。结果 53例MP阳性,感染率为59%,18株为敏感株,耐药率66%,32株存在23S rRNA 结构域Ⅴ区A2063G 点突变。3株2063、2064位点均有突变。结论 北京地区肺炎支原体感染率高,对大环内酯类抗生素耐药率上升趋势,耐药机制主要为23S rRNA 结构域Ⅴ区点突变。
Abstract
Objective To investigate the prevalence and mecharism of drug resistance of mycoplasma pneumoniae (MP) of children in Beijing area in 2015-2016.Method A total of 89 respiratory throat swab specimens were collected from children with fever,cough or sore throat and other respiratory tract infection symptoms,admitted in Beijing Chaoyang Hospital Affiliated to Capital Medical University in 2015-2016.These cases were assayed mycoplasma culture and drug sensitivity test and were amplified by nested PCR method for identification of MP resistance loci.Results 53 cases were positive of mycoplasma pneumonia,with infection rate of 59%.18 cases were sensitive strains and drug resistance rate was 66%.32 strains showed A2063G point mutation in 23S rRNA domain V district.Both A2063G and A2064G point mutation existed in 3 cases.Conclusions Mycoplasma pneumoniae infection rate in Beijing area is prevalent.The macrolide resistance rate is rising and the main resistance mechanism is 23S rRNA domain V point mutation.
关键词
肺炎支原体 /
耐药 /
大环内酯类 /
耐药机制
Key words
mycoplasma pneumonia /
drug resistance /
macrolides /
resistant mechanism
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 殷勇,陆权,闫晓莉,等.肺炎支原体感染的流行病学[J].中华儿科杂志,2016,54(2):91-93.
[2] Liu Y,Ye X,Zhang H,et al.Antimicrobial susceptibility of mycoplasma pneumoniae isolates and molecular analysis of macrolide-resistant strains from Shanghai,China [J].Antimicrob Agents Chemother,2009,53(5):2160-2162.
[3] Xin D,Mi Z,Han X,et al.Molecular mechanisms of macrolide resistance in clinical isolates of mycoplasma pneumoniae from China [J].Antimicrob Agents Chemother,2009,53(5):2158-2159.
[4] Zhou Z,Li X,Chen X,et al.Macrolide-resistant Mycoplasma pneumoniae in adults in Zhejiang,China [J].Antimicrob Agents Chemother,2015,59(2):1048-1051.
[5] Miyashita N,Oka M,Atypical Pathogen Study Group,et al.Macrolide-resistant mycoplasma pneumoniae in adults with community-acquired pneumonia[J].Int J Antimicrob Agents,2010,36(4):384-385.
[6] Kawai Y,Miyashita N,Yamaguchi T,et al.Clinical efficacy of macrolide antibiotics against genetically determined macrolide-resistant mycoplasma pneumoniae pneumonia in paediatric patients[J].Respiratory,2012,17(2):354-362.
[7] Dumke R,von Baum H,Lück PC,et al.Occurrence of macrolide-resistant Mycoplasma pneumoniae strains in Germany[J].Clin Microbiol Infect,2010,16(6):613-616.
[8] Peuchant O,Ménard A,Renaudin H,et al.Increased macrolide resistance of Mycoplasma pneumoniae in France directly detected in clinical specimens by real-time PCR and melting curve analysis[J].J Antimicrob Chemother,2009,64(1):52-58.
[9] Zheng X,Lee S,Selvarangan R,et al.Macrolide-resistant mycoplasma pneumoniae,United States[J].Emerg Infect Dis,2015,21(8):1470-1472.
[10] Eshaghi A,Memari N,Tang P,et al.Macrolide-resistant mycoplasma pneumoniae in humans,Ontario,Canada,2010-2011[J].Emerg Infect Dis,2013,19(9):1525-1527.
[11] Bébéar CM,Pereyre S.Mechanisms of drug resistance in Mycoplasma pneumoniae [J].Curr Drug Targets Infect Disord,2005,5(3):263-271.
[12] Waites KB,Duffy LB,Bbar CM,et al.Standardized methods andquality control limits for agar and broth microdilution susceptibility testingof mycoplasma pneumoniae,Mycoplasma hominis,and Ureaplaurealyticum[J].J ClinMicrobiol,2012,50(11):3542-3547.
[13] Akaike H,Miyashita N,Kubo M,et al.In vitro activities of 11 antimicrobialagents against macrolide-resistant mycoplasma pneumoniaeisolatesfrom pediatric patients:results from a multicenter surveillancestudy[J].Jpn J Infect Dis,2012,65(6):535-538.
[14] 刘禧杰,辛德莉,李靖,等,肺炎支原体对大环内酯类抗生素的耐药分子机制[J].实用儿科临床杂志,2008,23 (22):1730-1733.
[15] 辛德莉,靡祖煌,韩旭,等,应用巢式聚合酶链反应和测序检测肺炎支原体23S rRNA 中点突变[J].中华儿科杂志,2008,46(7):522-525.
[16] 李靖,崔菲菲,辛德莉,等.儿童呼吸道肺炎支原体感染耐药现状[J].实用儿科临床杂志,2009,24(22):1717-1719.
[17] Xin D,Mi Z,Han X,et al.Molecular mechanisms of macrolide resistance in clinical isolates of mycoplasma pneumoniae from China[J].Antimicmb Agents Chemother,2009,53(5):2158-2159.
[18] Liu Y,Ye X,Zhang H,et al.Antimicrobial susceptibility of Mycoplasma pneumoniae isolates and molecular analysis on macrolide-resisant strains from Shanghai China[J].Antimicrobial Agents and Chemotherapy,2009,53(5):2160-2163.
[19] 韩晓华,路素坤,李书秀,等.肺炎支原体23SrRNA基因突变及其所致肺炎的临床分析[J].中国医科大学学报,2011,40(2):162-165.
[22] 李静宜,孙岚,秦选光,等.实时定量PCR检测肺炎支原体2063位点点突变的方法学研究[J].中国全科医学,2013,16 (11):3774-3777.
基金
北京市科学技术委员会资助项目(Z131100004013029);首都医科大学附属北京友谊医院院级课题(BJYYYY2011-31)
PDF(553 KB)
