关于诊断和治疗儿童耐大环内酯肺炎支原体肺炎的专家共识。

IF 6.1 2区 医学 Q1 PEDIATRICS World Journal of Pediatrics Pub Date : 2024-09-01 Epub Date: 2024-08-14 DOI:10.1007/s12519-024-00831-0
Ying-Shuo Wang, Yun-Lian Zhou, Guan-Nan Bai, Shu-Xian Li, Dan Xu, Li-Na Chen, Xing Chen, Xiao-Yan Dong, Hong-Min Fu, Zhou Fu, Chuang-Li Hao, Jian-Guo Hong, En-Mei Liu, Han-Min Liu, Xiao-Xia Lu, Zheng-Xiu Luo, Lan-Fang Tang, Man Tian, Yong Yin, Xiao-Bo Zhang, Jian-Hua Zhang, Hai-Lin Zhang, De-Yu Zhao, Shun-Ying Zhao, Guo-Hong Zhu, Ying-Xue Zou, Quan Lu, Yuan-Yuan Zhang, Zhi-Min Chen
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引用次数: 0

摘要

背景:肺炎支原体(M. pneumoniae)是儿童社区获得性肺炎的主要致病菌。自 1968 年日本首次报道对大环内酯类抗生素耐药的肺炎支原体菌株以来,全球许多国家都发现了对大环内酯类抗生素耐药的肺炎支原体(MRMP),其发病率各不相同。MRMP感染导致患者对大环内酯类抗生素反应不佳,经常导致发热时间延长、抗生素治疗时间延长、住院率增加、入住重症监护室以及接受糖皮质激素或二线抗生素治疗的患者比例明显增加。自2000年以来,全球MRMP的发病率逐渐上升,尤其是在东亚地区,这给儿童肺炎霉菌感染的治疗带来了严峻的挑战,引起了儿科医生的广泛关注。然而,目前全球对儿童 MRMP 的诊断和治疗仍未达成共识:方法:我们组织了国内 29 位儿科肺病学和流行病学专家,在收集证据的基础上,撰写了全球首个关于儿童 MRMP 肺炎诊断和治疗的共识。我们使用电子数据库进行了证据检索和综述,包括 PubMed、Embase、Web of Science、CNKI、Medline 和 Cochrane Library。我们使用了 "耐大环内酯类药物"、"肺炎支原体"、"MP"、"肺炎杆菌"、"肺炎"、"MRMP"、"下呼吸道感染"、"肺炎支原体感染"、"儿童 "和 "儿科 "等不同术语:重点介绍了流行病学、发病机制、临床表现、早期识别、实验室检查、抗生素使用原则、糖皮质激素和静脉注射免疫球蛋白的应用以及支气管镜检查的注意事项。目前可通过呼吸道标本中的聚合酶链反应和荧光探针技术,早期快速识别与 MRMP 相关的基因突变。虽然肺炎霉菌对大环内酯类抗生素的耐药率仍然很高,但幸运的是,肺炎霉菌对四环素类和喹诺酮类等二线抗生素仍然保持着良好的体外敏感性,这使它们成为大环内酯类抗生素初次治疗失败患者的有效治疗选择:该共识基于国际和国内的科学证据,为儿童 MRMP 的诊断和治疗提供了科学指导。目前急需进一步研究四环素类和喹诺酮类药物对儿童生长发育的影响。此外,有必要制定抗生素轮换治疗策略,以减少 MRMP 菌株的流行。
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Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children.

Background: Mycoplasma pneumoniae (M. pneumoniae) is a significant contributor to community-acquired pneumonia among children. Since 1968, when a strain of M. pneumoniae resistant to macrolide antibiotics was initially reported in Japan, macrolide-resistant M. pneumoniae (MRMP) has been documented in many countries worldwide, with varying incidence rates. MRMP infections lead to a poor response to macrolide antibiotics, frequently resulting in prolonged fever, extended antibiotic treatment, increased hospitalization, intensive care unit admissions, and a significantly higher proportion of patients receiving glucocorticoids or second-line antibiotics. Since 2000, the global incidence of MRMP has gradually increased, especially in East Asia, which has posed a serious challenge to the treatment of M. pneumoniae infections in children and attracted widespread attention from pediatricians. However, there is still no global consensus on the diagnosis and treatment of MRMP in children.

Methods: We organized 29 Chinese experts majoring in pediatric pulmonology and epidemiology to write the world's first consensus on the diagnosis and treatment of pediatric MRMP pneumonia, based on evidence collection. The evidence searches and reviews were conducted using electronic databases, including PubMed, Embase, Web of Science, CNKI, Medline, and the Cochrane Library. We used variations in terms for "macrolide-resistant", "Mycoplasma pneumoniae", "MP", "M. pneumoniae", "pneumonia", "MRMP", "lower respiratory tract infection", "Mycoplasma pneumoniae infection", "children", and "pediatric".

Results: Epidemiology, pathogenesis, clinical manifestations, early identification, laboratory examination, principles of antibiotic use, application of glucocorticoids and intravenous immunoglobulin, and precautions for bronchoscopy are highlighted. Early and rapid identification of gene mutations associated with MRMP is now available by polymerase chain reaction and fluorescent probe techniques in respiratory specimens. Although the resistance rate to macrolide remains high, it is fortunate that M. pneumoniae still maintains good in vitro sensitivity to second-line antibiotics such as tetracyclines and quinolones, making them an effective treatment option for patients with initial treatment failure caused by macrolide antibiotics.

Conclusions: This consensus, based on international and national scientific evidence, provides scientific guidance for the diagnosis and treatment of MRMP in children. Further studies on tetracycline and quinolone drugs in children are urgently needed to evaluate their effects on the growth and development. Additionally, developing an antibiotic rotation treatment strategy is necessary to reduce the prevalence of MRMP strains.

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来源期刊
World Journal of Pediatrics
World Journal of Pediatrics 医学-小儿科
CiteScore
10.50
自引率
1.10%
发文量
592
审稿时长
2.5 months
期刊介绍: The World Journal of Pediatrics, a monthly publication, is dedicated to disseminating peer-reviewed original papers, reviews, and special reports focusing on clinical practice and research in pediatrics. We welcome contributions from pediatricians worldwide on new developments across all areas of pediatrics, including pediatric surgery, preventive healthcare, pharmacology, stomatology, and biomedicine. The journal also covers basic sciences and experimental work, serving as a comprehensive academic platform for the international exchange of medical findings.
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