Correlation Analysis Between Drug-Resistance Gene Mutation With Refractory Mycoplasma Pneumoniae Pneumonia In Children

BackgroundMycoplasma pneumoniae pneumonia(MPP)is more common in children community acquired pneumonia(CAP),because of the structure specificity of MPP,macrolide antibiotics are the preferred choice for treatment.However,due to the wide application of macrolide antibiotics in recent years,some children with MP had poor efficacy on macrolide antibiotics,resulting in refractory mycoplasma pneumoniae pneumonia(RMPP)cases.At present,the occurrence mechanism of RMPP is not clear,research shows that it may be related to MP resistance of MP is closely related to mutations of V domain A2063 G and A2064 G of 23 S rRNA,so the thesis investigates the correlation between mutations of MP drug resistance genes A2063 G and A2064 G in bronchoalveolar lavage fluid(BALF)of children with MP and RMPP.ObjectivesTo compare the clinical characteristics of RMPP group and non-RMPP group,drug resistance gene mutation group and non-mutation group,and investigate the correlation between MP drug resistance genes mutation and the Clinical Features of RMPP.MethodsThe bronchoalveolar lavage fluid(BALF)of 48 cases with MPP were collected by fiberoptic bronchoscopy during the acute stage of the disease as experiment specimens,which were divided into RMPP group and non-RMPP group according to the diagnostic criteria of RMPP,and also divided into gene mutation group and non-mutation group by fluorescence quantitative PCR.The differences of clinical manifestations,laboratory tests and imaging findings of each group were retrospectively analyzed and compared,the clinical features of RMPP were analyzed by Logistic regression analysis,and whether mutations in drug resistance gene were related to RMPP was summarized.Results1.Among 48 cases,there were 31 cases(64.6%)with A2063 G and/or A2064 G gene mutations(35.4%),17 cases(35.4%)without gene mutations;there were 31 cases(64.6%)with RMPP,17 cases(35.4%)without RMPP,23 cases(74.2%)with gene mutation in 31 children with RMPP,8 cases(47.1%)with gene mutation in 17 non-RMPP group,although the mutation rate was high in RMPP group,it was not statistically significant by Chi-square test(P>0.05).2.Compared with children without gene mutations,MPPs with drug resistance gene mutations were older,hypersensitive C-reactive protein and MP-DNA were more,the time of fever,hospital stays,application of macrolide antibiotics and fever clearance after application were longer,extrapulmonary complications were more and the change under fiber bronchoscopy was more serious,the differences were statistically significant(P<0.05)and the remainder were not statistically significant(P>0.05).3.Compared with non-RMPP group,for RMPP group,hypersensitive C-reactive protein was higher,the time of cough,fever,hospital stays,application of macrolide antibiotics and fever clearance after application were longer,extrapulmonary complications were more,imaging changes and changes under fiberoptic bronchoscopy were more severe,the differences were statistically significant(P<0.05)and the remainder were not statistically significant(P>0.05).4.Logistic regression analysis showed no significant correlation between mutations in drug resistance gene and RMPP(P>0.05).ConclusionThe application time of macrolide antibiotics in children with RMPP is longer than that in non-RMPP children;The occurrence of RMPP is not only determined by drug resistance genes,but also the result of a combination of factors.