中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2013年
10期
756-761
,共6页
鲍芳%曲久鑫%刘振嘉%秦选光%曹彬
鮑芳%麯久鑫%劉振嘉%秦選光%曹彬
포방%곡구흠%류진가%진선광%조빈
肺炎,支原体%大环内酯类%抗药性,细菌%儿童
肺炎,支原體%大環內酯類%抗藥性,細菌%兒童
폐염,지원체%대배내지류%항약성,세균%인동
Pneumoniae,Mycoplasma%Macrolides%Drug resistance,bacterial%Child
目的 了解儿童社区获得性肺炎(CAP)中支原体肺炎的临床及影像学特点,以及阿奇霉素体外耐药菌株所致支原体肺炎的治疗效果.方法 前瞻性连续入选首都医科大学附属北京朝阳医院儿科病房2010年9月1日至2011年8月31日收治的179例CAP患儿,均进行咽分泌物肺炎支原体核酸检测及肺炎支原体体外培养,培养阳性者进行体外药物敏感度测定.结果 179例CAP中确诊支原体肺炎的患儿83例(46％),肺炎支原体培养阳性45例,其中44株体外药敏试验结果显示对大环内酯类药物高度耐药(MR),1例大环内酯体外敏感.44例MR肺炎患儿的临床表现为持续性发热、咳嗽,大多为高热[(39.5±0.7)℃],咳嗽呈刺激性干咳；外周血白细胞大多正常[(8±4)×109/L],中性粒细胞比例正常或升高(0.60±0.94),ESR[(24± 14) mm/1 h]及C反应蛋白(12.8 mg/L)均增高.44例MR肺炎X线胸部正位片显示大叶性实变影10例(23％,10/44),其中左下肺3例,左肺2例,右下肺3例,右上肺2例；少量胸腔积液1例合并右下肺实变；斑片样炎性渗出影27例；肺纹理增重7例.44例MR肺炎支原体肺炎患者中19例进行了胸部CT检查,13例存在肺叶或肺段实变.44例MR肺炎平均在发病第4天接受阿奇霉素治疗,平均疗程为(9±4)d.12例初选抗生素为头孢或青霉素(1例青霉素),41例使用阿奇霉素过程中联合使用头孢或青霉素类抗生素(1例联合青霉素类抗生素).阿奇霉素治疗后平均发热时间为(6±3)d；治疗后咳嗽持续时间为(17±5)d；将44例MR肺炎患儿根据肺部影像学检查分为大叶性肺实变组及无肺实变组,大叶性肺实变组患儿发热时间及给予大环内酯类药物(阿奇霉素)后发热时间均较非实变组长,差异有统计学意义(P＜0.05).结论 肺炎支原体对大环内酯的耐药率高达98％ (44/45).MR感染合并大叶性肺实变者发热时间及给予大环内酯类药物后发热时间较非肺实变者延长.本组44例MR肺炎患儿预后良好,无肺外严重并发症.
目的 瞭解兒童社區穫得性肺炎(CAP)中支原體肺炎的臨床及影像學特點,以及阿奇黴素體外耐藥菌株所緻支原體肺炎的治療效果.方法 前瞻性連續入選首都醫科大學附屬北京朝暘醫院兒科病房2010年9月1日至2011年8月31日收治的179例CAP患兒,均進行嚥分泌物肺炎支原體覈痠檢測及肺炎支原體體外培養,培養暘性者進行體外藥物敏感度測定.結果 179例CAP中確診支原體肺炎的患兒83例(46％),肺炎支原體培養暘性45例,其中44株體外藥敏試驗結果顯示對大環內酯類藥物高度耐藥(MR),1例大環內酯體外敏感.44例MR肺炎患兒的臨床錶現為持續性髮熱、咳嗽,大多為高熱[(39.5±0.7)℃],咳嗽呈刺激性榦咳；外週血白細胞大多正常[(8±4)×109/L],中性粒細胞比例正常或升高(0.60±0.94),ESR[(24± 14) mm/1 h]及C反應蛋白(12.8 mg/L)均增高.44例MR肺炎X線胸部正位片顯示大葉性實變影10例(23％,10/44),其中左下肺3例,左肺2例,右下肺3例,右上肺2例；少量胸腔積液1例閤併右下肺實變；斑片樣炎性滲齣影27例；肺紋理增重7例.44例MR肺炎支原體肺炎患者中19例進行瞭胸部CT檢查,13例存在肺葉或肺段實變.44例MR肺炎平均在髮病第4天接受阿奇黴素治療,平均療程為(9±4)d.12例初選抗生素為頭孢或青黴素(1例青黴素),41例使用阿奇黴素過程中聯閤使用頭孢或青黴素類抗生素(1例聯閤青黴素類抗生素).阿奇黴素治療後平均髮熱時間為(6±3)d；治療後咳嗽持續時間為(17±5)d；將44例MR肺炎患兒根據肺部影像學檢查分為大葉性肺實變組及無肺實變組,大葉性肺實變組患兒髮熱時間及給予大環內酯類藥物(阿奇黴素)後髮熱時間均較非實變組長,差異有統計學意義(P＜0.05).結論 肺炎支原體對大環內酯的耐藥率高達98％ (44/45).MR感染閤併大葉性肺實變者髮熱時間及給予大環內酯類藥物後髮熱時間較非肺實變者延長.本組44例MR肺炎患兒預後良好,無肺外嚴重併髮癥.
목적 료해인동사구획득성폐염(CAP)중지원체폐염적림상급영상학특점,이급아기매소체외내약균주소치지원체폐염적치료효과.방법 전첨성련속입선수도의과대학부속북경조양의원인과병방2010년9월1일지2011년8월31일수치적179례CAP환인,균진행인분비물폐염지원체핵산검측급폐염지원체체외배양,배양양성자진행체외약물민감도측정.결과 179례CAP중학진지원체폐염적환인83례(46％),폐염지원체배양양성45례,기중44주체외약민시험결과현시대대배내지류약물고도내약(MR),1례대배내지체외민감.44례MR폐염환인적림상표현위지속성발열、해수,대다위고열[(39.5±0.7)℃],해수정자격성간해；외주혈백세포대다정상[(8±4)×109/L],중성립세포비례정상혹승고(0.60±0.94),ESR[(24± 14) mm/1 h]급C반응단백(12.8 mg/L)균증고.44례MR폐염X선흉부정위편현시대협성실변영10례(23％,10/44),기중좌하폐3례,좌폐2례,우하폐3례,우상폐2례；소량흉강적액1례합병우하폐실변；반편양염성삼출영27례；폐문리증중7례.44례MR폐염지원체폐염환자중19례진행료흉부CT검사,13례존재폐협혹폐단실변.44례MR폐염평균재발병제4천접수아기매소치료,평균료정위(9±4)d.12례초선항생소위두포혹청매소(1례청매소),41례사용아기매소과정중연합사용두포혹청매소류항생소(1례연합청매소류항생소).아기매소치료후평균발열시간위(6±3)d；치료후해수지속시간위(17±5)d；장44례MR폐염환인근거폐부영상학검사분위대협성폐실변조급무폐실변조,대협성폐실변조환인발열시간급급여대배내지류약물(아기매소)후발열시간균교비실변조장,차이유통계학의의(P＜0.05).결론 폐염지원체대대배내지적내약솔고체98％ (44/45).MR감염합병대협성폐실변자발열시간급급여대배내지류약물후발열시간교비폐실변자연장.본조44례MR폐염환인예후량호,무폐외엄중병발증.
Objective To investigate the drug resistance of Mycoplasma pneumoniae among children with community-acquired pneumonia (CAP),and to explore the clinical and radiological characteristics of and the role of azithromycin in the treatment of of macrolide-resistant (MR) Mycoplasma pneumoniae pneumonia.Methods Cases of CAP in children (n =179) were prospectively enrolled in the Pediatric ward of Beijing Chaoyang Hospital from 1 st September,2010 to 31st August 2011.Pharyngeal swabs were collected for detection of Mycoplasma pneumoniae DNA.Mycoplasma pneumoniae culture and in vitro susceptibility testing were also performed.Results Eighty-three cases met the diagnostic criteria of mycoplasma pneumonia,accounting for 46％ of the CAP patients.Mycoplasma pneumoniae culture was positive in 45 cases,including 44 highly resistant to macrolides (MR) in vitro,and 1 sensitive.The 44 cases caused by MR pathogen presented with fever for (8 ± 3) d and cough for (17 ± 5) d,with higher fever (39.5 ± 0.7) ℃ and more irritating dry cough.In most of the children,peripheral blood leukocytes (8 ± 4) × 109/L were normal,with normal or elevated (0.60 ± 0.94) neutrophils,normal or slightly elevated erythrocyte sedimentation rate [(24 ± 14) mm/1 h] and CRP (12.8 mg/L).Chest X-ray showed lobar consolidation in 10 cases (23％,10/44),among them 3 in the lower left lung,2 in the left lung,3 in the right lower lung,2 in the right upper lung.Pleural effusion (small amount),combined with right lower lung consolidation,was found in 1 case.Patchy shadows were found in 27 cases,and interstitial lung infiltrate in 7 cases.Of the 44 cases caused by MR Mycoplasma pneumoniae,19 had lung computed tomography (CT) scanning,among them 13 had lobar or segmental consolidation.Azithromycin therapy started in an average of 4.0 days after onset of illness,with duration of therapy averaging (9 ± 4) d.Cephalosporin or penicillin (n =1) was the initial antibiotic choice in 12 of them,while combination therapy with azithromycin and cephalosporin or penicillin antibiotics was given in 41 of them.The duration of fever averaged (6 ± 3) d after treatment of azithromycin and duration of cough averaged (17 ± 5) d after treatment.Among patients with MR Mycoplasma pneumonia,those with lobar consolidation had longer duration of fever after treatment with azithromycin,compared with those without consolidation (P ＜ 0.05).Conclusions The macrolide resistance rate was 98％ (44/45) in our patients.Fever and duration of therapy with azithromycin in MR infection was longer in patients with lobar consolidation.The 44 children with MR Mycoplasma pneumonia recovered with no serious complications.
