Emerging Macrolide Resistance in Mycoplasma Pneumoniae

描述（由申请人提供）：肺炎支原体是包括社区获得性肺炎在内的呼吸道感染的主要原因，并且该有机体是肺外并发症（如脑炎）的确定原因。目前用于治疗肺炎支原体感染的药物有三类：大环内酯类药物、四环素类药物和氟喹诺酮类药物。其中只有大环内酯类通常被认为可用于8岁以下儿童。最近来自欧洲和亚洲的流行病学数据表明，肺炎支原体迅速而广泛地出现大环内酯类药物耐药性。然而，目前在美国没有对肺炎支原体的抗生素耐药性进行监测，以使医生了解这一问题的范围。我们建议对阿拉巴马州儿童大环内酯类药物耐药性进行监测研究，使用传统培养和基于分子的方法检测肺炎支原体呼吸道感染，并评估基于pcr的检测方法，该方法将在临床标本中直接检测大环内酯类药物耐药性。我们还计划对肺炎支原体分离株进行分型，以确定耐药性是否在整个人群中频繁发生，或者耐药菌株是否正在发生克隆传播。应用分子方法检测临床标本中的大环内酯类药物耐药性对医生充分治疗由该生物引起的严重感染至关重要。公共卫生相关性：肺炎支原体是人类呼吸道感染的主要原因。最近来自欧洲和亚洲的报告显示，对阿奇霉素等大环内酯类抗生素的耐药性迅速而广泛地上升，但对这一问题在美国的严重程度尚不清楚，也没有前瞻性研究提供任何监测数据。我们建议在儿童中进行一项前瞻性研究，使用传统培养和基于分子的方法来检测肺炎支原体的抗生素耐药性。

DESCRIPTION (provided by applicant): Mycoplasma pneumoniae is major cause of respiratory infections including community acquired pneumonia, and the organism is an established cause of extrapulmonary complications such as encephalitis. At present three classes of drugs are used to treat M. pneumoniae infections: macrolides, tetracyclines, and fluoroquinolones. Of these only macrolides are generally considered acceptable for use in children under the age of 8 years. Recent epidemiologic data from Europe and Asia have documented the rapid and extensive emergence of macrolide resistance in M. pneumoniae. However, there is at present no surveillance of antibiotic resistance in M. pneumoniae in the United States to give physicians an idea of the scope of this problem. We propose to conduct a surveillance study of macrolide resistance in children in Alabama using traditional culture and molecular-based methods for detection of M. pneumoniae respiratory infections and to evaluate a PCR-based assay that will detect macrolide resistance directly in clinical specimens. We also plan to sub-type M. pneumoniae isolates to determine whether resistance is occurring frequently throughout the population or if clonal spread of resistant strains is occurring. The application of molecular methods to detect macrolide resistance in clinical specimens is essential for physicians to adequately treat serious infections cause by this organism. PUBLIC HEALTH RELEVANCE: Mycoplasma pneumoniae is a major cause of respiratory infections in humans. Recent reports from Europe and Asia have documented a rapid and extensive rise in resistance to macrolide antibiotics such as azithromycin, but there is no knowledge about the extent of this problem in the United States and no prospective studies to provide any surveillance data. We propose to conduct a prospective study in children using traditional culture and molecular-based methods to test for antibiotic resistance in M. pneumoniae.