哮喘是一个重要的公共卫生问题,特别是有严重症状的儿童。哮喘(EOA)的恶化会危及生命,和呼吸道感染(RI)起着至关重要的作用。尽管病毒在EOA中起着重要作用,患者接受抗生素的经验性治疗,有助于抗生素耐药性的发展。尽管有广泛报道的EOA与病毒或肺炎支原体感染的关联,斯里兰卡没有公布的数据。本研究旨在确定常见呼吸道病毒的关联,EOA儿童中典型的呼吸道细菌病原体和肺炎支原体,并将它们与抗菌药物使用的相容性联系起来。在北科伦坡教学医院儿科进行了病例对照研究,斯里兰卡,涉及两组5至15岁的儿童。第1组是患有EOA的儿童,第2组是患有稳定哮喘(SA)的儿童。每组由100名儿童组成。使用病毒特异性异硫氰酸荧光素标记的单克隆抗体(MAb)测试痰/咽拭子的常见呼吸道病毒,通过常规培养细菌,和肺炎支原体通过实时聚合酶链反应。使用常规PCR和测序23SrRNA基因中的特异性基因突变来检测肺炎支原体中的大环内酯抗性。肺炎支原体使用嵌套多位点序列分型进行基因分型,针对八个管家基因(ppa,PGM,gyrB,gmk,glyA,atpA,arcC和adk)。在年龄上没有显著差异,性别,两组之间的人口统计或地理位置。在患有EOA的儿童中,66%(66/100)使用抗生素,42%(42/100)使用大环内酯类.样品包括78%(78/100)痰和22%(22/100)咽拭子。腺病毒是最常见的病毒,与患有SA的儿童相比,EOA的儿童明显更高。尽管如此,两组典型细菌的发现无显著差异.在一名EOA患者中检测到肺炎支原体,但在SA组中没有检测到。肺炎支原体对大环内酯敏感,多位点序列分型为ST14。这项研究表明,在哮喘患儿中经验性使用抗生素可能会更好地针对先前的病原体筛查,以告知适当的治疗以最大程度地减少抗生素耐药性。
Asthma is a significant public health concern, particularly in children with severe symptoms. Exacerbation of asthma (EOA) is life-threatening, and respiratory infections (RIs) play a crucial role. Though viruses play a significant role in EOA, patients are empirically treated with antibiotics, contributing to antibiotic resistance development. Although there are widely reported associations of EOA with viral or Mycoplasma pneumoniae infections, there are no published data for Sri Lanka. The present
study aimed to identify the association of common respiratory viruses, typical respiratory bacterial pathogens and M. pneumoniae in children with EOA and relate them with the compatibility of antimicrobial use. A case-control
study was conducted in the paediatric unit of North Colombo Teaching Hospital, Sri Lanka, involving two groups of children between 5 and 15 years of age. Group 1 is children with EOA and Group 2 is children with stable asthma (SA). Each group consisted of 100 children. Sputum/throat swabs were tested for common respiratory viruses using virus-specific fluorescein isothiocyanate-labelled monoclonal antibodies (MAbs), bacteria by routine culture, and M. pneumoniae by real-time polymerase chain reaction. Macrolide resistance in M. pneumoniae was detected using conventional PCR and sequencing specific genetic mutations in the 23S rRNA gene. M. pneumoniae was genotyped using nested multilocus sequence typing, which targeted eight housekeeping genes (ppa, pgm, gyrB, gmk, glyA, atpA, arcC and adk). There was no significant difference in age, gender, demographic or geographical location between the two groups. In children with EOA, antibiotics were used in 66 % (66/100) and macrolides in 42 % (42/100). Samples comprised 78 % (78/100) sputum and 22 % (22/100) throat swabs. Adenovirus was the most common virus identified, and it was significantly higher in children with EOA compared to those with SA. Still, the two groups had no significant difference in typical bacteria findings. M. pneumoniae was detected in one patient with EOA, but none was detected in the SA group. The M. pneumoniae was macrolide-sensitive and ST14 by multilocus sequence typing. This
study showed that the empiric use of antibiotics in children with asthma might be better targeted with prior pathogen screening to inform appropriate treatment to minimize antibiotic resistance.