Emergence of macrolide-resistant strains during an outbreak of Mycoplasma pneumoniae infections in children
Emergence of macrolide-resistant strains during an outbreak of Mycoplasma pneumoniae infections in children
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DOI：
10.1093/jac/dkr003
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发表时间：
2011-04-01
影响因子：
5.2
通讯作者：
Cardinale, F.
中科院分区：
文献类型：
--
作者：
Chironna, M.;Sallustio, A.;Cardinale, F.
目的：肺炎支原体是人类下呼吸道感染（LRTIs）的常见原因，大环内酯类药物是治疗的选择。本研究的目的是确定意大利大环内酯类药物和肺炎支原体亚型菌株的耐药率。患者和方法：在2010年意大利南部肺炎支原体感染暴发期间，对43名因下呼吸道感染住院的儿科患者的48份临床标本进行了大环内酯类药物耐药性分析。通过测序23S rRNA基因的靶结构域V区和MPN528a基因的一个区域，分别检测与耐药相关的突变（A2063G和A2064G）和肺炎支原体亚型。结果：43例肺炎分枝杆菌阳性患儿中检出大环内酯类耐药基因型11例（26%）。在7例患者中鉴定出A2063G突变，在其余4例患者中鉴定出A2064G突变。入院时，来自3名患者的分离株显示易感基因型，但随后获得A2063G突变。基因分型显示40株测序菌株中有33株为1型肺炎支原体，其余7株为2型肺炎支原体。大环内酯耐药或敏感性与肺炎支原体亚型之间无相关性。结论：这是意大利首次报道肺炎支原体对大环内酯类药物耐药。我们的研究结果表明，大环内酯类药物耐药基因型在儿童中的患病率出乎意料地高，因此，在对抗生素治疗没有适当反应的患者中，应仔细考虑大环内酯类药物耐药性。在意大利和欧洲其他国家，有必要对大环内酯类药物耐药性进行流行病学监测。
Objectives: Mycoplasma pneumoniae is a frequent cause of human lower respiratory tract infections (LRTIs) for which macrolides are the treatment of choice. The aim of this study was to determine the rate of macrolide resistance and to subtype M. pneumoniae strains in Italy.Patients and methods: During an outbreak of M. pneumoniae infections in southern Italy in 2010, 48 clinical specimens from 43 paediatric patients hospitalized for LRTIs were analysed for macrolide resistance. The mutations associated with resistance (A2063G and A2064G) and M. pneumoniae subtypes were detected by sequencing the targeted domain V region of the 23S rRNA gene and a region in the MPN528a gene, respectively.Results: Macrolide resistance genotypes were detected in 11 (26%) of the 43 M. pneumoniae-positive children. The A2063G mutation was identified in seven patients and the A2064G mutation was identified in the remaining four. Upon admission, the isolates from three patients showed a susceptible genotype but subsequently acquired the A2063G mutation. Genotyping revealed M. pneumoniae subtype 1 in 33 of 40 sequenced strains and subtype 2 in the remaining 7. There was no association between macrolide resistance or susceptibility and the M. pneumoniae subtypes.Conclusions: This is the first report of macrolide resistance among M. pneumoniae strains in Italy. Our findings indicate an unexpected high prevalence of macrolide resistance genotypes in children, and so macrolide resistance should be carefully considered in patients who do not respond appropriately to antibiotic treatment. The epidemiological monitoring of macrolide resistance has become necessary in Italy and in the rest of Europe.