阿奇霉素开始治疗时间对肺炎支原体肺炎临床转归的影响
|
摘要
目的:评价阿奇霉素不同开始治疗时间对肺炎支原体肺炎(MPP)临床转归的影响。方法:选择2016-2017年在我院就诊的MPP患儿335例,按照阿奇霉素开始治疗时间分为早期干预组(发病≤72 h) 109例和晚期干预组(发病>72 h) 226例,均给予阿奇霉素干混悬剂10 mg/(kg·d)晨起顿服,先口服3～5 d,停药3～4 d,再口服3 d,疗程9～12 d,比较两组患儿的临床转归情况及肺外并发症发生率。结果:两组的总病程及严重MPP、肺不张、胸腔积液比例比较差异均无统计学意义(P均>0. 05),而早期干预组肺外并发症发生率为17. 43%,低于晚期干预组的28. 32%(χ2=4. 68,P<0. 05)。治疗后随访结果显示,两组患儿的WBC、CRP、肺不张、胸腔积液复常率比较差异均无统计学意义(P均>0. 05)。结论:阿奇霉素早期使用并不能进一步改善MPP的临床症状及预后,但可以降低肺外并发症的发生率。
Objective: To evaluate the effects of initiation time of azithromycin on clinical outcomes of Mycoplasma pneumoniae pneumonia( MPP). Methods: Totally 355 children with MPP admitted into our hospital from 2016 to 2017 were extracted to be divided into the early intervention group( n = 109)( onset≤72 h) and the advanced intervention group( n = 226)( onset > 72 h) according to initiation time of azithromycin. All patients were given azithromycin dry suspension 10 mg/( kg · d) in the morning,with oral administration for 3 to 5 d,discontinuation of 3 ～ 4 d,and then oral administration for 3 d,the course of treatment was 9 to 12 d. The clinical outcomes and incidence of extra-pulmonary complications were compared between two groups. Results: There was no significant difference between two groups in total course of disease and proportion of severe MPP,atelectasis,pleural effusion( P>0. 05),but the incidence of extra-pulmonary complications in the early intervention group(17. 43%) was lower than of the advanced intervention group(28. 32%),there was significant difference between two groups(χ2= 4. 677,P< 0. 05). The follow-up results after treatment showed that there was no significant difference in the proportion of WBC,CRP,atelectasis,and pleural effusion between two groups( P>0. 05).Conclusion: Early application of azithromycin does not further improve the clinical symptoms and prognosis of MPP,but can reduce the incidence of extrapulmonary complications.
Objective: To evaluate the effects of initiation time of azithromycin on clinical outcomes of Mycoplasma pneumoniae pneumonia( MPP). Methods: Totally 355 children with MPP admitted into our hospital from 2016 to 2017 were extracted to be divided into the early intervention group( n = 109)( onset≤72 h) and the advanced intervention group( n = 226)( onset > 72 h) according to initiation time of azithromycin. All patients were given azithromycin dry suspension 10 mg/( kg · d) in the morning,with oral administration for 3 to 5 d,discontinuation of 3 ～ 4 d,and then oral administration for 3 d,the course of treatment was 9 to 12 d. The clinical outcomes and incidence of extra-pulmonary complications were compared between two groups. Results: There was no significant difference between two groups in total course of disease and proportion of severe MPP,atelectasis,pleural effusion( P>0. 05),but the incidence of extra-pulmonary complications in the early intervention group(17. 43%) was lower than of the advanced intervention group(28. 32%),there was significant difference between two groups(χ2= 4. 677,P< 0. 05). The follow-up results after treatment showed that there was no significant difference in the proportion of WBC,CRP,atelectasis,and pleural effusion between two groups( P>0. 05).Conclusion: Early application of azithromycin does not further improve the clinical symptoms and prognosis of MPP,but can reduce the incidence of extrapulmonary complications.
引文
[1]DAI W,WANG H,ZHOU Q,et al.The concordance between upper and lower respiratory microbiota in children with Mycoplasma pneumoniae pneumonia[J].Emerg Microbes Infect,2018,7(1):92.
[2]ISHIGURO N,KOSEKI N,KAIHO M,et al.Therapeutic efficacy of azithromycin,clarithromycin,minocycline and tosufloxacin against macrolide-resistant and macrolide-sensitive Mycoplasma pneumoniae pneumonia in pediatric patients[J].PLoS One,2017,12(3):e0173635.
[3]WAITES K B,CRABB D M,DUFFY L B,et al.In vitro activities of lefamulin and other antimicrobial agents against macrolidesusceptible and macrolide-resistant Mycoplasma pneumoniae from the United States,Europe,and China[J].Antimicrob Agents Chemother,2017,61(2):e2008-e2016.
[4]LI S,SUN H,LIU F,et al.Two case reports:whole genome sequencing of two clinical macrolide-resistant Mycoplasma pneumoniae isolates with different responses to azithromycin[J].Medicine(Baltimore),2016,95(38):e4963.
[5]YANG D,CHEN L,CHEN Z.The timing of azithromycin treatment is not associated with the clinical prognosis of childhood Mycoplasma pneumoniae pneumonia in high macrolide-resistant prevalence settings[J].PLoS One,2018,13(1):e0191951.
[6]中华医学会儿科学分会呼吸学组,《中华实用儿科临床杂志》编辑委员会.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华实用儿科临床杂志,2015,30(17):1304-1308.
[7]MOROZUMI M,OKADA T,TAJIMA T,et al.Killing kinetics of minocycline,doxycycline and tosufloxacin against macrolideresistant Mycoplasma pneumoniae[J].Int J Antimicrob Agents,2017,50(2):255-257.
[8]PEREYRE S,TOUATI A,PETITJEAN-LECHERBONNIER J,et al.The increased incidence of Mycoplasma pneumoniae in France in 2011 was polyclonal,mainly involving M.pneumoniae type 1strains[J].Clin Microbiol Infect,2013,19(4):E212-E217.
[9]DUMKE R,STOLZ S,JACOBS E,et al.Molecular characterization of macrolide resistance of a Mycoplasma pneumoniae strain that developed during therapy of a patient with pneumonia[J].Int J Infect Dis,2014,29:197-199.doi:10.1016/j.ijid.2014.07.014.
[10]OKADA T,MOROZUMI M,TAJIMA T,et al.Rapid effectiveness of minocycline or doxycycline against macrolideresistant Mycoplasma pneumoniae infection in a 2011 outbreak among Japanese children[J].Clin Infect Dis,2012,55(12):1642-1649.
[11]ZHOU Y,ZHANG Y,SHENG Y,et al.More complications occur in macrolide-resistant than in macrolide-sensitive Mycoplasma pneumoniae pneumonia[J].Antimicrob Agents Chemother,2014,58(2):1034-1038.
[12]BIONDI E,MCCULLOH R,ALVERSON B,et al.Treatment of Mycoplasma pneumonia:A systematic review[J].Pediatrics,2014,133(6):1081-1090.
[13]SHANGGUAN Z,SUN Q,ZHANG M,et al.Mycoplasma pneumoniae infection in hospitalized adult patients with community-acquired pneumonia in China[J].J Infect Dev Ctries,2014,8(10):1259-1266.
[14]LIONG T,LEE K L,POON Y S,et al.Extrapulmonary involvement associated with Mycoplasma pneumoniae infection[J].Hong Kong Med J,2015,21(6):569-572.
[15]盛江吟,李昌崇,张海邻,等.不同疗程阿奇霉素治疗儿童轻症肺炎支原体肺炎疗效比较[J].儿科药学杂志,2018,24(1):10-12.
[16]MISHRA R,CANO E,VENKATRAM S,et al.An interesting case of Mycoplasma pneumonia associated multisystem involvement and diffuse alveolar hemorrhage[J].Respir Med Case Rep,2017,3(21):78-81.
[2]ISHIGURO N,KOSEKI N,KAIHO M,et al.Therapeutic efficacy of azithromycin,clarithromycin,minocycline and tosufloxacin against macrolide-resistant and macrolide-sensitive Mycoplasma pneumoniae pneumonia in pediatric patients[J].PLoS One,2017,12(3):e0173635.
[3]WAITES K B,CRABB D M,DUFFY L B,et al.In vitro activities of lefamulin and other antimicrobial agents against macrolidesusceptible and macrolide-resistant Mycoplasma pneumoniae from the United States,Europe,and China[J].Antimicrob Agents Chemother,2017,61(2):e2008-e2016.
[4]LI S,SUN H,LIU F,et al.Two case reports:whole genome sequencing of two clinical macrolide-resistant Mycoplasma pneumoniae isolates with different responses to azithromycin[J].Medicine(Baltimore),2016,95(38):e4963.
[5]YANG D,CHEN L,CHEN Z.The timing of azithromycin treatment is not associated with the clinical prognosis of childhood Mycoplasma pneumoniae pneumonia in high macrolide-resistant prevalence settings[J].PLoS One,2018,13(1):e0191951.
[6]中华医学会儿科学分会呼吸学组,《中华实用儿科临床杂志》编辑委员会.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华实用儿科临床杂志,2015,30(17):1304-1308.
[7]MOROZUMI M,OKADA T,TAJIMA T,et al.Killing kinetics of minocycline,doxycycline and tosufloxacin against macrolideresistant Mycoplasma pneumoniae[J].Int J Antimicrob Agents,2017,50(2):255-257.
[8]PEREYRE S,TOUATI A,PETITJEAN-LECHERBONNIER J,et al.The increased incidence of Mycoplasma pneumoniae in France in 2011 was polyclonal,mainly involving M.pneumoniae type 1strains[J].Clin Microbiol Infect,2013,19(4):E212-E217.
[9]DUMKE R,STOLZ S,JACOBS E,et al.Molecular characterization of macrolide resistance of a Mycoplasma pneumoniae strain that developed during therapy of a patient with pneumonia[J].Int J Infect Dis,2014,29:197-199.doi:10.1016/j.ijid.2014.07.014.
[10]OKADA T,MOROZUMI M,TAJIMA T,et al.Rapid effectiveness of minocycline or doxycycline against macrolideresistant Mycoplasma pneumoniae infection in a 2011 outbreak among Japanese children[J].Clin Infect Dis,2012,55(12):1642-1649.
[11]ZHOU Y,ZHANG Y,SHENG Y,et al.More complications occur in macrolide-resistant than in macrolide-sensitive Mycoplasma pneumoniae pneumonia[J].Antimicrob Agents Chemother,2014,58(2):1034-1038.
[12]BIONDI E,MCCULLOH R,ALVERSON B,et al.Treatment of Mycoplasma pneumonia:A systematic review[J].Pediatrics,2014,133(6):1081-1090.
[13]SHANGGUAN Z,SUN Q,ZHANG M,et al.Mycoplasma pneumoniae infection in hospitalized adult patients with community-acquired pneumonia in China[J].J Infect Dev Ctries,2014,8(10):1259-1266.
[14]LIONG T,LEE K L,POON Y S,et al.Extrapulmonary involvement associated with Mycoplasma pneumoniae infection[J].Hong Kong Med J,2015,21(6):569-572.
[15]盛江吟,李昌崇,张海邻,等.不同疗程阿奇霉素治疗儿童轻症肺炎支原体肺炎疗效比较[J].儿科药学杂志,2018,24(1):10-12.
[16]MISHRA R,CANO E,VENKATRAM S,et al.An interesting case of Mycoplasma pneumonia associated multisystem involvement and diffuse alveolar hemorrhage[J].Respir Med Case Rep,2017,3(21):78-81.