The Research Of Related Factors About The Hospitalized Children With Refractory Mycoplasma Pneumoniae Pneumonia

Objective:In recent years, the proportion of atypical pneumonia caused by Mycoplasma pneumonia (mycoplasma pneumonia, MP) increases every year, and the effect of macrolide antibiotic treatment is obviously poor than before. The specific mechanism is not clear. The aim of this study is to investigate the incidence of refractory Mycoplasma pneumoniae pneumonia (RMPP) and its possible related factors, to provide a certain basis for early diagnosis and clinical treatment of RMPP.Methods:The31cases of children diagnosed as RMPP were come from hospitalized children with Mycoplasma pneumoniae pneumonia in November2010to December2011at the Shenzhen Children’s Hospital.31cases of Mycoplasma pneumonia (MPP) with similar age and gender were selected as a control group. Bacterial culture of airway aspirates, respiratory virus IgM antibody in serum with ELISA, macrolide resistance genes with nested-PCR amplification and sequencing, IL-1beta, IL-6, IL-10and TNF-factor alpha in serum with ELISA were undertaken. Clinical characteristics including use of antibiotics before and after admission, response of macrolide administrion, fever, clinical course, severity, laboratory abnormality, other treatment and outcome were observed.Results:In293hospitalized cases with MP pneumonia,31cases were diagnosed as RMPP, the incidence is10.58%. The total febrile days and hospital stay days in RMPP group are longer than the MPP group (average febrile days:10.39±6.296vs4.32±3.333; average hospital stay days:10.45±3.623vs6.55±1.588). No statistically significant difference in mixed infection with respiratory virus (11%vs0) and bacteria (12.9%vs19.4%) are founded between two groups. There is no significantly difference of macrolide-resistant rate between two groups (55.5%vs35.5%). The levels of IgM ((2.05±1.85vs1.74±0.94), IgA (9.66±3.38vs9.55±3.45), IgG (1.31±0.75vs1.32±0.68), C3(3:1.07±0.25vs1.16±0.21) and C4(4:0.25±0.08vs0.275±0.11) have no significantly difference between two groups. The average levels of IL-1beta (28.086±6.338vs11.117±3.274), IL-6(38.199±8.203vs11.117±3.122), IL-10(17.044±4.196vs10.924±3.046) and TNF-factor alpha (17.542±4.234vs10.869±3.202) in RMPP group are higher than that of MPP group, but there is only a significantly difference of IL-6levels. Uses of glucocorticoid, IVIG and fiberoptic bronchoscopy in RMPP group are increased frequently.Conclusion:The development of RMPP may have no relationship with the mixed infections and macrolide-resistance. However, RMPP may be result from excessive inflammatory responses.