摘要
目的分析肺炎支原体(MP)肺炎患儿大环内酯类抗生素(MA)耐药的危险因素,旨在为MP肺炎患儿的治疗提供合理建议。方法采集2018年6月-2019年6月本市儿童医院呼吸科病房收治的168例MP肺炎患儿的咽拭子标本,检测MP的DNA、MA耐药基因,依据耐药性检测结果分为MA耐药组、MA敏感组,对比分析两组人口学特征、临床特征、实验室指标等,Logistics回归分析MP肺炎患儿MA耐药的危险因素。结果入组168例MP肺炎患儿,共65例对MA耐药,占38.69%(65/168);MP肺炎患儿的MA耐药率在年龄分布、发病季节上存在明显的差异,其中学龄期MA耐药率、冬春季MA耐药率显著高于同类其它(P<0.05);与MA敏感组相比,MA耐药组发热时间、高热时间明显长,且肺外并发症、治疗方式为单纯基础治疗、不规律用药次数≥4次占比明显高(P<0.05);Logistic回归分析得出年龄分布、发病季节、肺外并发症、治疗方式、不规律用药次数是MP肺炎患儿MA耐药的影响因素(P<0.05)。结论需加强对学龄期或冬春季发病的MP肺炎患儿的MA耐药监测,建议临床治疗中,在单纯基础治疗上或可与激素或丙种球蛋白等联合进行,同时对患儿家属强调规律用药的重要性,对降低MA耐药率至为关键。
Objective To analyze the risk factors for macrolides antibiotics(MA)resistance in children with mycoplasma pneumoniae(MP)pneumonia so as to provide reasonable advice for the treatment of children with MP pneumonia.Methods Throat swab specimens from 168 children with MP pneumonia admitted to the respiratory department of children's hospital from June 2018 to June 2019 were collected.The DNA and MA resistance genes of MP were detected.According to the drug resistance test results,the specimens were divided into the MA-resistant group and the MA-sensitive group.The demographic characteristics,clinical features and laboratory indexes of the two groups were comparatively analyzed.Logistics regression analysis was performed to analyze the risk factors for MA resistance in children with MP pneumonia.Results Among the 168 children with MP pneumonia enrolled in the study,there were 65 patients resistant to MA,accounting for 38.69%(65/168).There were significant differences in MA resistance rate of children with MP pneumonia in terms of age and onset season.The MA resistance rates in school age and in winter and spring were significantly higher than those in other same aspects(P<0.05).Compared with the MA-sensitive group,the duration of fever and high fever was significantly longer,and the proportions of extrapulmonary complications,simple basic treatment and frequency of irregular medication≥4 times were obviously higher in the MA-resistant group(P<0.05).Logistic regression analysis showed that age,onset season,extrapulmonary complications,treatment methods and frequency of irregular medication were risk factors affecting MA resistance in children with MP pneumonia(P<0.05).Conclusion It is necessary to strengthen the monitoring of MA resistance in children with MP pneumonia which attacks in school age or in winter and spring.It is recommended that in clinical treatment,simple basic treatment can be combined with hormones or gamma globulins,and the family members should be told the importance of regular medication,which is critical to reducing MA resistance.
作者
陈先平
王娟
洪岩
张立胜
CHEN Xian-ping;WANG Juan;HONG Yan;ZHANG Li-sheng(Department of Pediatric,Ankang Hospital of Traditional Chinese Medicine,Ankang,Shaanxi 725000,China)
出处
《临床肺科杂志》
2020年第9期1385-1388,共4页
Journal of Clinical Pulmonary Medicine
关键词
肺炎支原体
肺炎
大环内酯类抗生素
耐药
危险因素
Mycoplasma pneumoniae
pneumonia
macrolides antibiotics
drug resistance
risk factors
