Emerging Macrolide Resistance in Mycoplasma pneumoniae in Children

23S核糖体RNA 肺炎支原体 微生物学 生物 病毒学 抗药性 大环内酯类抗生素 肺炎 红霉素 基因 医学 抗生素 核糖核酸 遗传学 核糖体 内科学
作者
Li Xiao,T. Prescott Atkinson,James S. Hagood,C. Makris,Lynn B. Duffy,Ken B. Waites
出处
期刊:Pediatric Infectious Disease Journal [Ovid Technologies (Wolters Kluwer)]
卷期号:28 (8): 693-696 被引量:106
标识
DOI:10.1097/inf.0b013e31819e3f7a
摘要

Background: Epidemiologic data from Asia have documented the rapid and extensive emergence of macrolide resistance in Mycoplasma pneumoniae. This drug resistance has also been documented in Europe and recently in the United States, but there is very little information currently available on its prevalence. A rapid technique to identify macrolide-resistant M. pneumoniae is needed to guide management of patients with community-acquired respiratory infections. Methods: Culture and Minimum Inhibitory Concentration testing identified macrolide-resistant M. pneumoniae infection in 2 seriously ill hospitalized children with community-acquired pneumonia. A portion of the 23S ribosomal RNA gene from 2 macrolide-resistant M. pneumoniae isolates from these children as well as 4 laboratory-induced macrolide-resistant strains was amplified by PCR, and the PCR products were sequenced to identify mutations associated with macrolide resistance. A real-time PCR assay was designed to identify 3 known mutations in the 23S rRNA gene associated with macrolide resistance and applied to the clinical specimens from which these isolates were obtained and to the bacterial isolates. Results: Macrolide-resistant M. pneumoniae from both children were found to carry an A2063G transition in the 23S rRNA gene previously identified in resistant isolates from China, Japan, France, and recently in an encephalitis outbreak in Rhode Island. Three laboratory-induced mutant strains had an A2064G mutation whereas the other one had an A2063G mutation. A real-time PCR assay successfully detected the macrolide-resistant M. pneumoniae directly in clinical specimens and discriminated them from wild-type isolates. Conclusions: Macrolide-resistant M. pneumoniae can be associated with prolonged severe respiratory infection in children. Real-time PCR offers a rapid method of diagnosing macrolide resistance in community-acquired respiratory infections due to M. pneumoniae.
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