关键词: 肺炎支原体, 耐大环内酯, 基因突变, 难治性肺炎支原体肺炎, 支气管肺泡灌洗液, 纤维支气管镜检查

Abstract:

Objective To elucidate the clinical significance in facilitating timely diagnosis and treatment of RMPP in children by investigating the association between infection caused by macrolide?resistant Mycoplasma pneumoniae （MRMP） and refractory Mycoplasma pneumoniae pneumonia （RMPP） in pediatric patients. Methods The clinical data of 714 hospitalized children with refractory Mycoplasma pneumoniae pneumonia （RMPP） were retrospectively analyzed. Bronchoscopy and bronchoalveolar lavage fluid （BALF） were performed on each subject， and the BALFs were collected to detect mutation sites in the V region of 23S rRNA for Mycoplasma pneumoniae DNA. Based on the gene detection results， children with RMPP were categorized into a macrolide?resistant group and a control group （non?macrolide?resistant group）. Results A total of 714 children diagnosed with refractory Mycoplasma pneumoniae pneumonia （RMPP） were enrolled in this study， including 509 cases in the macrolide?resistant group and 205 cases in the control group. Among them， there were 369 males （54.7%） and 345 females （45.3%）. The macrolide?resistant group exhibited higher average age， fever duration， and hospitalization days compared to the control group. Furthermore， elevated levels of white blood cell count （WBC）， neutrophil percentage （NE%）， high?sensitivity C?reactive protein （hs?CRP）， lactate dehydrogenase （LDH）， and interleukin?6 （IL?6） were observed in the macrolide?resistant group when compared to the control group （P < 0.05 or P < 0.000 1）. Compared to the control group， children with macrolide?resistant Mycoplasma pneumoniae pneumonia （RMPP） exhibited higher incidences of lung consolidation， pleural effusion， necrotic pneumonic lesions， severe MPP （SMPP）/fulminant MPP （FMPP）， flocculent and viscous tracheal secretions， severe mucosal lesions （erosion， ulceration or necrosis）， bronchial inflammatory stenosis， endo?bronchial plastic phlegm plugs and extra?pulmonary complications （P < 0.05 or P < 0.0001）. Conclusions MRMP infection can contribute to the development of RMPP， potentially exacerbating respiratory conditions in affected children. Timely bronchoscopy and collection of BALF samples for accurate evaluation of respiratory tract lesions and detection of MRMP infection have significant implications for guiding precise clinical diagnosis and treatment.

Key words: mycoplasma pneumoniae, macrolides resistant, gene mutation, refractory mycoplosma pneumoniae pneumonia, bronchoalveolar lavage fluid, bronchoscopy