探讨女性泌尿生殖道支原体感染(GTMI)的临床特点与采集泌尿生殖道分泌物标本的抗菌药物耐药率。

选择2014年8月至2020年12月，于广州医科大学附属广州市妇女儿童医疗中心进行泌尿生殖道解脲脲原体(UU)和人型支原体(MH)培养的30 952例疑似GTMI女性为研究对象。采用回顾性研究方法，根据疑似GTMI女性年龄，将其分为3组，适龄组(n＝22 863，年龄≥20~35岁)，高龄组(n＝7 786，年龄≥35~60岁)与老龄组(n＝303，年龄≥60岁)。采集疑似GTMI女性宫颈拭子分泌物标本，采用液体培养法进行UU和MH及其对抗菌药物耐药率检测。采用χ²检验与线性趋势χ²检验，对3组疑似GTMI女性的GTMI发生率、2014—2020年GTMI发生率逐年变化趋势及单纯UU与UU+MH患者宫颈拭子分泌物标本对抗菌药物耐药率，以及耐药率逐年变化趋势进行统计学比较。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。

①本研究30 952例疑似GTMI女性中，GTMI总体发生率为39.2%(12 130/30 952，95%CI: 38.7%~39.7%)。2014—2020年，疑似GTMI女性GTMI发生率总体变化呈逐年上升趋势(χ²＝191.19，P<0.001)。②12 130例GTMI患者中，单纯UU患者占比为82.1%(9 956/12 130)，显著高于UU+MH患者(15.9%，1 934/12 130)，并且差异有统计学意义(χ²＝10 614.62，P<0.001)；单纯UU、UU+MH患者占比，均显著高于单纯MH患者(2.0%，240/12 130)，并且差异亦均有统计学意义(χ²＝15 970.82、1 449.91，P<0.001)。2014-2020年，单纯UU患者和单纯MH患者占比均呈逐年下降趋势(χ²＝124.29、17.46，P<0.001)，而UU+MH患者占比，则呈逐年上升趋势(χ²＝176.09，P<0.001)。③适龄组疑似GTMI女性的GTMI发生率为41.6%(9 505/22 863)，显著高于高龄组的32.3%(2 516/7 786)和老龄组的36.0%(109/303)，并且差异均有统计学意义(χ²＝208.51、3.86，P<0.001、＝0.049)。2014—2020年，适龄组和高龄组疑似GTMI女性的GTMI发生率均呈逐年上升趋势(χ²＝134.00、84.50，P<0.001)。④UU+MH患者宫颈拭子分泌物标本对多西环素、盐酸米诺环素、环丙沙星、氧氟沙星、司帕沙星、罗红霉素、阿奇霉素、克拉霉素、交沙霉素及大观霉素的耐药率，均显著高于单纯UU者，并且差异均有统计学意义(P<0.001)。单纯UU和UU+MH患者宫颈拭子分泌物标本对多西环素、盐酸米诺环素和交沙霉素耐药率均较低，分别为2.8%(280/9 956)与12.5%(241/1 934)，6.8%(682/9 956)与16.4%(317/1 934)，1.1%(113/9 956)与14.4%(278/1 934)。2014—2020年，单纯UU与UU+MH患者宫颈拭子分泌物标本对大观霉素耐药率，均呈逐年上升趋势(χ²＝184.89、56.19，P<0.001)。

2014—2020年，本研究疑似GTMI女性中，适龄女性的GTMI发生率明显呈逐年上升趋势，对多种抗菌药物耐药率较高。

To explore clinical characteristics of genitourinary tract Mycoplasma infection (GTMI) in female and its resistance rate of antimicrobial resistance rate of collected cervical swab specimens.

A total of 30 952 females with suspected GTMI who underwent urogenital Ureaplasma urealyticum (UU) and Mycoplasma hominis (MH) culture in Guangzhou Women and Children′s Medical Center, Guangzhou Medical University were selected as research subjects. They were divided into 3 groups according to the age: childbearing-age group (n=22 863, ≥20-35 years), senior-age group (n=7 786, ≥35-60 years), and elder group (n=303, ≥60 years) by retrospective study method. Cervical swab specimens were collected for detection of UU and MH infection and its drug resistance by broth method. Incidence of GTMI among 3 groups, change trend of incidence of GTMI from 2014 to 2020, and antimicrobial resistance rate of collected cervical swab specimens in patients with UU infection and UU+ MH combined infection and their change trend from 2014 to 2020 were compared by chi-square test and linear trend chi-square test. This study was conducted in accordance with the requirements of Helsinki Declaration of the World Medical Association revised in 2013.

①Among the 30 952 suspected GTMI females, incidence of GTMI was 39.2% (12 130/30 952, 95%CI: 38.7%-39.7%), and the incidence shown an overall upward trend from 2014 to 2020 (χ²=191.19, P<0.001). ②Among 12 130 cases of GTMI patients, the proportion of UU patients was 82.1% (9 956/12 130), which was significantly higher than the proportion of UU+ MH patients 15.9% (1 934/12 130), and the difference was significantly different (χ²=10 614.62, P<0.001). Proportions of UU patients and UU+ MH patients both were significantly higher than the proportion of MH patients 2.0% (240/12 130), and both differences were significantly different (χ²=15 970.82, 1 449.91; P<0.001). Proportions of UU patients and MH patients both showed a downward trend from 2014 to 2020 (χ²=124.29, 17.46; P<0.001), while proportion of UU+ MH patients showed an upward trend from 2014 to 2020 (χ²=176.09, P<0.001). ③Incidence of GTMI in childbearing-age group was 41.6% (9 505/22 863), which was significantly higher than that of senior-age group 32.3% (2 516/7 786) and elder group 36.0% (109/303), and both differences were statistically significant (χ²=208.51, 3.86; P<0.001, =0.049), and incidence of GTMI in childbearing-age group and senior-age group both showed upward trends from 2014 to 2020 (χ²=134.00, 84.50; P<0.001). ④Resistance rates of cervical swab specimens in UU+ MH patients to doxycycline, minocycline hydrochloride, ciprofloxacin, ofloxacin, sparfloxacin, roxithromycin, azithromycin, clarithromycin, josamycin, and spectinomycin, all were significantly higher than those of UU patients (P<0.001). Resistance rates of cervical swab specimens in UU patients and UU+ MH patients to doxycycline, minocycline, and josamycin were relatively low, which were 2.8% (280/9 956) and 12.5% (241/1 934), 6.8% (682/9 956) and 16.4% (317/1 934), and 1.1% (113/9 956) and 14.4% (278/1 934), respectively. Resistance rates of cervical swab specimens in UU patients and UU+ MH patients to spectinomycin both showed upward trends from 2014 to 2020 (χ²=184.89, 56.19; P<0.001).

From 2014 to 2020, incidence of GTMI in suspected GTMI female of childbearing age of this study shows a significant upward trend, and the resistance to multiple antibiotics is relatively severe.