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目的了解肺炎支原体对大环内酯类抗生素的耐药现状,提高对耐药肺炎支原体肺炎的临床认识和诊治水平。方法对2006年10月至2007年7月首都医科大学附属北京友谊医院儿科病房确诊为肺炎支原体肺炎的110例患儿,从其咽部或鼻咽部获取标本,利用肺炎支原体分离培养技术分离培养肺炎支原体并进行药物敏感试验,筛选耐药株;对24例确诊为耐药肺炎支原体肺炎住院患儿的临床特点进行总结和分析。结果肺炎支原体对大环内酯类抗生素有耐药株产生,110例标本中,分离肺炎支原体阳性株26例,耐药株24例,耐药率占92.31%,发病年龄多为学龄儿童,6～14岁占83.34%。持续发热5d伴刺激性咳嗽的患儿占100.00%,肺部无明显阳性体征。外周血白细胞大多正常(占83.33%),但发热期血沉(83.33%)及C反应蛋白(91.67%)都升高。胸片以一侧大片絮状阴影为多见,右侧12例(50.00%)多于左侧6例(25.00%),双侧6例(25.00%)。19例(79.17%)有肺外合并症,伴有渗出性胸膜炎者3例(12.5%)。阿奇霉素平均疗程9.4d。结论临床应认识到耐药肺炎支原体肺炎的存在;避免不合理使用抗生素。
Objective To understand the status of mycoplasma pneumoniae resistance to macrolide antibiotics and to improve the clinical knowledge and diagnosis and treatment of drug-resistant Mycoplasma pneumoniae pneumonia. Methods From October 2006 to July 2007, 110 children with pneumonia mycoplasma pneumonia were diagnosed in the pediatric ward of Beijing Friendship Hospital affiliated to Capital Medical University. Specimens were obtained from pharynx or nasopharynx and were isolated and cultured using Mycoplasma pneumoniae culture Mycoplasma pneumoniae and drug susceptibility testing, screening drug-resistant strains; 24 cases were diagnosed as resistant Mycoplasma pneumoniae hospitalized children clinical features were summarized and analyzed. Results Mycoplasma pneumoniae was resistant to macrolide antibiotics. Among 110 specimens, 26 cases were positive for Mycoplasma pneumoniae and 24 were drug-resistant strains, with drug-resistant rate accounting for 92.31%. The age of onset was mostly school-age children, 6 ~ 14 years old accounted for 83.34%. Persistent fever 5d with irritating cough in children accounted for 100.00%, no significant positive lung signs. Peripheral blood leukocytes were mostly normal (83.33%), but their erythrocyte sedimentation rate (83.33%) and C-reactive protein (91.67%) were elevated during febrile seasons. The chest radiographs were more common on the side of large flocculent shadows. There were 12 cases (50.00%) on the right and 6 cases (25.00%) on the left and 6 cases (25.00%) on both sides. Nineteen (79.17%) had extrapulmonary complication, with exudative pleurisy in 3 (12.5%). Azithromycin average treatment 9.4d. Conclusions The clinical should recognize the existence of drug-resistant Mycoplasma pneumoniae pneumonia and avoid the unreasonable use of antibiotics.