摘要
目的分析新型冠状病毒(SARS-CoV-2)疫情前后,医院上呼吸道常见病原体感染流行特征和肺炎支原体(MP)耐药性。方法以2022年6月-2023年12月在湖南中医药大学第一附属医院进行SARS-CoV-2核酸检测者和上呼吸道感染患者作为研究对象。分析呼吸道病原体在各月份、季节、性别和年龄段上阳性率的差异,以及混合感染情况。对MP阳性患者的咽拭子标本进行耐药基因Sanger测序,分析MP耐药位点突变情况。结果2022年12月,SARS-CoV-2核酸阳性率迅速增加,随后下降,至2023年5月SARS-CoV-2核酸阳性率达到最高峰(55.33%)。相比之下,其他6种呼吸道病原体总体阳性率在2023年1月降至最低峰(12.07%),随后快速上升,在2023年6月再次降至次低峰(38.58%)。SARS-CoV-2及6种呼吸道病原体在不同月份和季节中阳性率差异均有统计学意义(P<0.05);鼻病毒(hRV)、MP、腺病毒(ADV)、流感病毒A(IVA)、呼吸道合胞病毒(RSV)阳性率最高的年龄段分别是:婴儿期(24.76%)、少年期(35.07%)、儿童期(19.05%)、成年期(15.22%)、幼儿期(19.42%),各年龄段阳性率差异均有统计学意义(P<0.001)。6种呼吸道病原体中,混合感染率为17.83%,构成比从高到低排名前六位分别是:hRV+MP(19.92%)、hRV+ADV(16.53%)、hRV+RSV(13.94%)、MP+ADV(9.96%)、ADV+IVA(7.77%)和hRV+IVA(6.18%)。MP耐药基因测序中有84.85%的患者存在针对大环内酯类抗菌药物耐药的突变位点,均为23S rRNA V区A2063G点突变。结论SARS-CoV-2感染的上升拐点与其他呼吸道病原体感染的下降拐点呈现同步伴随状态。不同病原体好发年龄段和流行季节均有各自特征,目前流行的MP多为大环内酯类药物23S rRNA V区A2063G突变的耐药菌株。
OBJECTIVE To analyze the epidemic characteristics of common pathogens for upper respiratory tract infections(URTI)and the drug resistance of Mycoplasma pneumonia(MP)before and after the novel coronavirus(SARS CoV-2)epidemic.METHODS The study focused on individuals who underwent SARS-CoV-2 nucleic acid testing and patients with URTI at the First Affiliated Hospital of Hunan University of Chinese Medicine from Jun.2022 to Dec.2023.We analyzed the differences in the proportion of positive results of respiratory pathogens among the months,seasons,genders and age groups,as well as the situation of mixed infections.Sanger sequencing was performed on throat swab samples from MP-positive patients to analyze the mutation status of MP resistance sites.RESULTS In Dec.2022,the percentage of samples resulted positive for SARS-CoV-2 nucleic acid test increased rapidly and then decreased,with its peak of 55.33%in May 2023.In contrast,the percentage of samples resulted positive for six respiratory pathogens dropped to its lowest peak(12.07%)in Jan.2023,then rapidly increased,and again dropped to the second lowest peak(38.58%)in Jun.2023.The percentages of samples with positive SARS-CoV-2 and six respiratory pathogens showed statistically significant differences in different months and seasons(all P<0.05);The age groups with the highest proportion for human rhinovirus(hRV),MP,adenovirus(ADV),influenza A virus(IVA)and respiratory syncytial virus(RSV)were infancy(24.76%),adolescence(35.07%),childhood(19.05%),adulthood(15.22%)and infancy(19.42%),respectively;the differences in proportions among different age groups were statistically significant(all P<0.001).Among the 6 types of respiratory tract pathogens,the percentage of results with mixed infection was 17.83%,and the top six ranked from high to low were:hRV+MP(19.92%),hRV+ADV(16.53%),hRV+RSV(13.94%),MP+ADV(9.96%),ADV+IVA(7.77%)and hRV+IVA(6.18%).From the results of MP resistance gene sequencing,84.85%of patients carried mutation sites for resistance to macrolide antibiotics,all of which were 23S rRNA V region A2063 G point mutations.CONCLUSIONS The upward turning points of SARS-CoV-2 infection are accompanied by the downward turning points of other respiratory pathogen infections simultaneously.Different pathogens have their own characteristics on seasonal pattern and age distribution,and the current prevalent MP strains with 23S rRNA V region A2063 G point mutations are mostly macrolide resistant.
作者
郭俊龙
陈少强
周辉
邹睿琪
郭爱云
谢小兵
李萍
GUO Junlong;CHEN Shaoqiang;ZHOU Hui;ZOU Ruiqi;GUO Aiyun;XIE Xiaobing;LI Ping(The First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha,Hunan 410007,China)
出处
《中华医院感染学杂志》
北大核心
2025年第8期1220-1225,共6页
Chinese Journal of Nosocomiology
基金
湖南省中医药管理局一般项目(D2022112)
湖南省卫生健康高层次人才培养计划(湘卫函[2019]196号)
湖南中医药大学学科建设“揭榜挂帅”项目(22JBZ037)。
关键词
呼吸道感染
呼吸道病原体
流行病学
肺炎支原体
耐药性
Respiratory tract infection
Respiratory pathogens
Epidemiology
Mycoplasma pneumoniae
Drug resistance
作者简介
通讯作者:李萍,E-mail:lipingxt@163.com;郭俊龙(2001-),男,硕士在读,研究方向:肿瘤与感染性疾病分子诊断。
