Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013
Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013
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DOI：
10.1128/jcm.02597-14
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发表时间：
2015-01-01
影响因子：
9.4
通讯作者：
Winchell, Jonas M.
中科院分区：
文献类型：
--
作者：
Diaz, Maureen H.;Benitez, Alvaro J.;Winchell, Jonas M.
肺炎支原体是呼吸道感染的主要原因，包括社区获得性肺炎（CAP）。目前，初级保健机构并未常规进行病原体特异性检测，而且美国缺乏针对肺炎支原体的系统监测计划。通常仅在观察到严重疾病和/或经验性抗生素治疗未能改善时才会记录个别病例和集群病例。疫情经常发生，有些持续时间较长，病例数量较多。然而，由于缺乏诊断测试和结构化报告，更多的人可能未被识别。我们回顾了 2006 年至 2013 年间美国疾病控制与预防中心 (CDC) 支持的 17 项肺炎支原体感染病例、小群感染和暴发调查的数据。我们检查了在此期间收集的 199 份肺炎支原体阳性标本，以确定抗菌药物耐药性和传播类型的趋势。总体而言，在此期间发生的大约 10% 的肺炎支原体感染中发现了大环内酯类耐药性。菌株分型揭示了在此期间多个多位点可变数量串联重复分析 (MLVA) 和 P1 类型的共循环，包括在个别暴发中检测到的类型的多样性。三种 MLVA 类型（4572、3562 和 3662）占研究期间感染的 97%。为了了解美国肺炎支原体疾病的负担，促进病例和疫情的识别，并为适当的治疗和感染控制策略提供信息，有必要制定系统的监测计划。
Mycoplasma pneumoniae is a leading cause of respiratory infections, including community-acquired pneumonia (CAP). Currently, pathogen-specific testing is not routinely performed in the primary care setting, and the United States lacks a systematic surveillance program for M. pneumoniae. Documentation of individual cases and clusters typically occurs only when severe illness and/or failure to improve with empirical antibiotic therapy is observed. Outbreaks, some lasting for extended periods and involving a large number of cases, occur regularly. However, many more likely go unrecognized due to the lack of diagnostic testing and structured reporting. We reviewed data from 17 investigations of cases, small clusters, and outbreaks of M. pneumoniae infections that were supported by the Centers for Disease Control and Prevention (CDC) between 2006 and 2013. We examined 199 M. pneumoniae-positive specimens collected during this time period in order to identify trends in antimicrobial resistance and circulating types. Overall, macrolide resistance was identified in approximately 10% of M. pneumoniae infections occurring during this time period. Typing of strains revealed cocirculation of multiple multilocus variable-number tandem-repeat analysis (MLVA) and P1 types throughout this period, including diversity in types detected within individual outbreaks. Three MLVA types (4572, 3562, and 3662) accounted for 97% of the infections during the study period. A systematic surveillance program is necessary to understand the burden of M. pneumoniae disease in the United States, facilitate case and outbreak identification, and inform appropriate therapeutic and infection control strategies.