支原体肺炎患儿大环内酯类抗菌药物耐药的危险因素分析及风险评估模型的构建  

Analysis of risk factors and construction of risk assessment model for macrolide antibiotics resistance in children with mycoplasma pneumonia

作　　者：陈沛 刘文梅 CHEN Pei;LIU Wen-mei(Department of Pediatrics,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210031,China)

机构地区：[1]南京医科大学第四附属医院儿科,南京210031

出　　处：《临床药物治疗杂志》2023年第8期65-70,共6页Clinical Medication Journal

摘　　要：目的 探讨支原体肺炎患儿大环内酯类抗菌药物(MA)耐药的危险因素,并构建风险评估模型。方法 回顾性选取2020年1月1日至2021年12月1日南京医科大学第四附属医院收治的支原体肺炎患儿作为研究对象,根据患儿咽拭子标本的耐药性检测结果分为MA耐药组和MA敏感组,对比两组的一般资料和临床特征;多因素logistic回归分析影响支原体肺炎患儿MA耐药的危险因素;构建风险评估模型,采用受试工作者特征曲线(ROC)和校准曲线评价模型区分度和准确度。结果 共纳入100例支原体肺炎患儿,MA耐药组60例,MA敏感组40例。其中,MA耐药组85%患儿发生A2063G位点突变;MA耐药组患儿的临床表现主要为持续发热、高热、湿性啰音,出现喘鸣音和血氧饱和度降低并伴随肺外并发症。多因素logistic回归分析结果显示,有肺外症状(OR=5.380,95%CI:1.115~25.967)、住院时间≥7 d(OR=10.427,95%CI:1.661~65.460)和不规律用药次数≥4次(OR=7.666,95%CI:1.838~31.981)是支原体肺炎患儿MA耐药的危险因素(P<0.05);ROC曲线和校准曲线表明,风险评估模型工作效能良好。结论 MA耐药与患儿的肺外症状、住院时间和不规律用药次数有显著相关性,临床应重点关注这些问题,降低MA耐药的发生率。Objective To explore the risk factors of resistance to macrolide antibiotics(MA)in children with mycoplasma pneumonia,and construct a risk assessment model.Methods We retrospectively selected mycoplasma pneumonia children admitted to the Fourth Affiliated Hospital of Nanjing Medical University from January 1,2020 to December 1,2021.According to the antibiotic resistance test results of children's throat swab samples,they were divided into the MA resistant group and the MA sensitive group.The general information and clinical characteristics of the two groups were compared.Multivariate logistic regression analysis was used to identify the risk factors for MA resistance in children with mycoplasma pneumonia.A risk assessment model was constructed,and the receiver operator characteristic(ROC)curve and calibration curve were used to evaluate the model's discrimination and accuracy.Results A total of 100 mycoplasma pneumonia patients were included,60 in the MA resistant group and 40 in the MA sensitive group.Among them,85%of children in the MA resistant group had A2063G mutation.The clinical manifestations of children in the MA resistant group were mainly included persistent fever,high fever,moist rales,wheezing,decreased blood oxygen saturation and the occurrence of extrapulmonary complications.The results of multivariate logistic regression analysis showed that extrapulmonary symptoms(OR=5.380,95%CI:1.115 to 25.967),hospital stay≥7 days(OR=10.427,95%CI:1.661 to 65.460),and irregular medication use≥4 times(OR=7.666,95%CI:1.838 to 31.981)were risk factors for MA resistance in mycoplasma pneumonia children(P<0.05).The ROC and calibration curve showed that the risk assessment model preformed well.Conclusion There is a significant correlation between MA resistance and extrapulmonary symptoms,length of hospital stay,and irregular medication use in children.Clinical attention should be focused on these issues to reduce the incidence of MA resistance.

关 键 词：大环内脂类抗菌药物 支原体肺炎 耐药性 危险因素 

分 类 号：R978.1[医药卫生—药品]