To investigate the drug-resistance mutations and treatment of hospitalized children with Mycoplasma pneumoniae pneumonia (MPP) in Hunan Province. Children with pneumonia, who were hospitalized in the pediatric ward of the Second Xiangya Hospital of Central South University from January 1, 2023, to December 31, 2023, were enrolled in this study, and their clinical data was also collected. The targeted next-generation sequencing (tNGS) was used to detect Mycoplasma pneumoniae (MP) infection and drug-resistance mutations, and the drug-resistance and treatment in children with MPP were also analyzed. A total of 125 children with pneumonia were involved in this study, including 70 children in the MPP group and 55 children in the bacterial pneumonia group. The results showed that there were 41 boys and 29 girls with an average age of (6.50±3.45) years, with the most common group being the school-age group (age≥6 years). The clinical symptoms were characterized by fever and cough. Laboratory examination showed that the white blood cell and neutrophil counts in the MPP group were lower than those in the bacterial pneumonia group, while the lymphocyte ratio and hemoglobin levels in the MPP group were higher than those in the bacterial pneumonia group, with statistically significant differences (all P<0.05). Twelve children (17.14%) in the MPP group had severe pneumonia, and all children with severe pneumonia had 23Sr RNA A2063G and/or A2064G mutations. The tNGS detected 60 cases of MPP resistance gene mutations, including 59 cases (98.33%) of A2063G mutation in 23Sr RNA and one case (1.67%) of A2064G mutation in 23Sr RNA. There was a significant difference in the positive rate of drug-resistance mutations among patients of different age groups (χ2=7.991, P=0.021). A total of 63 children (90.00%) with MPP were treated according to the results of drug-resistance mutations, and seven children (70.00%) with MPP without drug-resistance mutations were treated according to the tNGS results. In children with the drug resistance of MPP, 46 cases (95.83%) of non-severe pneumonia and 10 cases (83.33%) of severe pneumonia were treated according to the tNGS results. All patients had a good prognosis, with no deaths reported and a median hospital stay M (Q1, Q3) of 9 (7, 11) days. In conclusion, MPP is more common in children aged≥6 years old in Hunan Province, and the detection of drug-resistant mutations includes A2063G and A2064G, with A2063G being the main one. The positive rate of drug-resistant mutations is related to age.
探讨湖南省儿童肺炎支原体肺炎（MPP）住院患者的耐药突变及治疗情况。以2023年1月1日至12月31日在中南大学湘雅二医院儿科病房住院治疗的肺炎患儿为研究对象，收集所有患儿的临床病历资料。采用靶向二代测序（tNGS）技术检测肺炎支原体（MP）的感染及耐药突变情况，分析MPP患儿的耐药及治疗情况。本研究共纳入125例肺炎患儿，其中MPP组患儿70例，细菌性肺炎组患儿55例。结果显示，70例MPP患儿男41例，女29例，年龄（6.50±3.45）岁，以学龄组（年龄≥6岁）最为多见。临床症状以发热、咳嗽为突出表现，实验室检查白细胞、中性粒细胞计数水平低于细菌性肺炎组，淋巴细胞比值、血红蛋白水平高于细菌性肺炎组，差异均有统计学意义（均P<0.05）；MPP组重症肺炎共12例（17.14%），重症肺炎患儿检出23Sr RNA A2063G和（或）A2064G突变。tNGS检出MPP耐药基因突变位点共60例，其中耐药基因23Sr RNA的A2063G基因位点突变59例（98.33%），耐药基因23Sr RNA的A2064G基因位点突变1例（1.67%）。不同年龄组患者之间的耐药突变阳性率差异有统计学意义（χ2=7.991，P=0.021）；共63例（90.00%）MPP患儿按耐药突变分析结果指导抗感染治疗，其中7例（70.00%）MPP不伴耐药突变的患儿参考tNGS结果指导抗感染治疗，MPP检出耐药的患儿非重症肺炎46例（95.83%）、重症肺炎10例（83.33%）参考tNGS结果指导抗感染治疗。所有患儿预后良好，未出现死亡病例，住院时间M（Q1， Q3）为9（7，11）d。综上，MPP在湖南省儿童中的年龄分布以≥6岁儿童多见，耐药突变位点检出包括A2063G、A2064G，以A2063G为主，耐药突变阳性率与年龄有关。.