儿童耐药肺炎支原体肺炎抗生素选择及免疫 药物治疗

Antibiotic Selection and Immunotherapeutic Agent Therapy for Pediatric Drug-Resistant Mycoplasma Pneumoniae Pneumonia

摘要: 肺炎支原体(MP)是社区获得性肺炎的主要病原体之一，多见于儿童与青少年群体，其中5岁及以上儿童为高发人群。肺炎支原体肺炎(MPP)是由MP感染引发的呼吸道疾病，大环内酯类抗菌药物为目前国内外指南推荐的MPP首选治疗药物。但近年来，MP对大环内酯类抗菌药物的耐药率在全球呈逐年上升趋势，我国大环内酯类耐药肺炎支原体(MRMP)的检出率更是持续处于高位，直接导致该类药物疗效降低，进而引发患儿病程延长、重症感染发生率升高、肺内外并发症增多等不良结局，不仅给临床治疗带来严峻挑战，也已成为国内外学界关注的热点问题。本文系统地综述了MP感染的流行病学特征、耐药机制及治疗策略，为临床选择抗菌药物及优化治疗方案提供参考依据。

Abstract: Mycoplasma pneumoniae (MP) is one of the primary pathogens of community-acquired pneumonia, and it is predominantly prevalent in children and adolescents, with children aged 5 years and older being the most affected group. Mycoplasma pneumoniae pneumonia (MPP) is a respiratory tract disease caused by MP infection, and macrolide antibiotics are the first-line therapeutic agents recommended for MPP in clinical guidelines both domestically and internationally. In recent years, however, the drug resistance rate of MP to macrolide antibiotics has been rising year by year globally, and the detection rate of macrolide-resistant Mycoplasma pneumoniae (MRMP) has remained persistently high in China. This has directly led to reduced efficacy of such antibiotics, subsequently resulting in adverse outcomes in pediatric patients including prolonged disease course, increased incidence of severe infections, and a higher prevalence of intrapulmonary and extrapulmonary complications. It not only poses formidable challenges to clinical management but also has become a major research focus among scholars worldwide. This paper systematically reviews the epidemiological characteristics, drug resistance mechanisms and therapeutic strategies of MP infection, aiming to provide a reference for the clinical selection of antibacterial agents and the optimization of treatment regimens.