Low Bacterial Co-infection Invalidates the Early Use of Non-anti-Mycoplasma pneumoniae Antibiotics in Pediatric Refractory Mycoplasma pneumoniae Pneumonia Patients.

Jin-Rong Liu,Yong-Li Guo,Hui Liu,Xiao-Lei Tang,Shun-Ying Zhao,Hui-Min Li,Jie Lu,Fang Dong

doi:10.3389/fped.2018.00296

Abstract

Background: Childhood refractory mycoplasma pneumoniae (MP) pneumonia (RMPP) is a lung disease with elevated level of C-reactive protein and severe clinical and radiological deterioration. Whether bacterial co-infection contributes to disease of RMPP and whether inclusion of non-anti-MP antibiotics in treatment regimen would benefit RMPP patients remains elusive.Methods: We retrospectively reviewed the medical records of 675 RMPP children. Traditional bacterial culture and next generation sequencing (NGS) were used to detect bacteria in bronchoalveolar lavage fluid in all the 675 patients and 18 patients respectively. Antibiotics used and clinical outcomes were analyzed along with other clinical measurements.Results: Positive bacterial cultures were only found in 18 out of 675 cases (2.67%) and NGS analyses of another 18 cases did not revealed positive bacterial infection, which were consistent with the results of bacterial cultures. Non-anti-MP antibiotics were utilized in 630 cases (93.33%), even last-line antibiotics, such as glycopeptides or carbapenems, were frequently used.Conclusion: Bacterial co-infection in RMPP was rare and non-anti-MP antibiotics didn't show any efficacy for early treatment of RMPP patients, which may provide a rationale for restricting the use of non-anti-MP antibiotics in RMPP patients and preventing antibiotic resistance globally.

Highlights

Mycoplasma pneumoniae (MP) pneumonia (MPP) in children is a significant public health problem
We retrospectively reviewed the medical records of 675 pediatric patients diagnosed with refractory MPP (RMPP) who were admitted in the Department of Respiratory Medicine II at Beijing Children’s Hospital between January 2008 and December 2015
RMPP was diagnosed according to the following criteria: [1] patients with MPP had persistent fever and deterioration of clinical and radiological findings after administration of macrolide antibiotics for 7 days or more [1, 14, 15]; [2] peripheral blood C-reactive protein (CRP) were higher than 40 mg/L, an useful indicator of RMPP [3]

Summary

Introduction

Mycoplasma pneumoniae (MP) pneumonia (MPP) in children is a significant public health problem. Most refractory MPP (RMPP) patients received treatments of macrolides followed by tetracyclines or quinolones. In clinic CRP levels higher than 40 mg/L (sometimes higher than 160 mg/L, normal range < 8 mg/L) would prompt clinicians to consider potential bacterial co-infection and prescribe both non-anti-MP and anti-MP antibiotics to RMPP patients. Whether it is necessary to combine non-anti-MP antibiotics along with anti-MP antibiotics for children RMPP patients with CRP more than 40 mg/L needs to be further defined. Childhood refractory mycoplasma pneumoniae (MP) pneumonia (RMPP) is a lung disease with elevated level of C-reactive protein and severe clinical and radiological deterioration. Whether bacterial co-infection contributes to disease of RMPP and whether inclusion of non-anti-MP antibiotics in treatment regimen would benefit RMPP patients remains elusive

Methods

Results

Conclusion