Abstract
Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides.
Highlights
Mycoplasma pneumoniae is one of the major causative pathogens of community-acquired pneumonia in children
Chest radiography findings at admission showed that bronchopneumonia was more common in the macrolide-sensitive M. pneumoniae pneumonia (MSMP) group, whereas the proportions of lobar pneumonia and bronchopneumonia were similar in the macrolide-refractory M. pneumoniae pneumonia (MrMP) group
This is the first large-scale study to perform an extensive review of data on the clinical, radiological, and diagnostic characteristics of patients with M. pneumoniae pneumonia (MP) who showed a refractory response to initial macrolide treatment
Summary
Mycoplasma pneumoniae is one of the major causative pathogens of community-acquired pneumonia in children. This pneumonia follows a cyclic epidemic pattern. Either a polymerase chain reaction (PCR) for 23S rRNA mutations or a minimum inhibitory concentration measurement using M. pneumoniae cultures is required. PCR assays to identify point-mutations in 23S rRNA are currently commercially unavailable, and it takes at least 2 weeks to obtain culture results [5,6]. For these reasons, it is practically impossible to use information on macrolide resistance in clinical practice. In the early period of MP, predicting responsiveness to macrolide treatment as well as the macrolide susceptibility of M
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