Abstract
Background: The clinical value of corticosteroid treatment in Mycoplasma pneumoniae pneumonia (MPP) has been controversial. Our study aimed to identify the effects of low-dose corticosteroids on the recovery of children with MPP.Methods: In this retrospective cohort study, pediatric inpatients with MPP were included from the Shanghai Children's Mycoplasma pneumoniae pneumonia cohort study between August 2014 and July 2019. The multivariable logistic regression and propensity-score matching were used to investigate the effects of low-dose corticosteroid treatment on fever duration after admission, total fever duration, length of hospital stay, C-reactive protein recovery time, and imaging recovery time with the stratification of severe pneumonia, refractory pneumonia, inflammatory biomarkers, pulmonary images, and timing of corticosteroids.Results: There were 548 patients in the corticosteroid group and 337 in the no-corticosteroid group. The corticosteroid group showed severe clinical parameters such as more severe and refractory cases, higher laboratory values, and more abnormal imaging manifestations. The corticosteroid group also showed longer fever duration after admission [odds ratio (OR) = 1.9 (95% CI, 1.2–3.1), P = 0.008], longer total fever duration [OR = 1.6 (95% CI, 1.1–2.3), P = 0.011], longer hospital stay [OR = 2.8 (95% CI, 1.9–4.0), P < 0.001], and longer C-reactive protein (CRP) recovery time [OR = 2.1 (95% CI, 1.1–3.9), P = 0.021] in the regression model after the adjustment for severity. Although low-dose corticosteroids were associated with shortened imaging recovery time in patients with high level laboratory values, pulmonary imaging could be completely recovered in both groups. The trend of these results was consistent even after stratifications and a propensity scores matching analysis.Conclusions: Low-dose corticosteroids may not be beneficial in children inpatients with MPP, and further studies on proper treatment modality are needed in the MRMP era.
Highlights
Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia (CAP) in children, accounting for 10–40% [1]
Low-dose corticosteroids were associated with shortened imaging recovery time in patients with high level laboratory values, pulmonary imaging could be completely recovered in both groups
Low-dose corticosteroids may not be beneficial in children inpatients with Mycoplasma pneumoniae pneumonia (MPP), and further studies on proper treatment modality are needed in the macrolide-resistant Mycoplasma pneumoniae (MRMP) era
Summary
Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia (CAP) in children, accounting for 10–40% [1]. Facing with the increasing rate of macrolide-resistant Mycoplasma pneumoniae (MRMP) strains detection and the limitations of alternative antibiotics use on MP infection in children, the need for early immune-modulator treatment (mainly corticosteroids) based on pathogenesis of MPP is of great concern. Early control of lung injuries from initial hyperactive immune reactions is crucial for the reduction in morbidity and prevention of progression in patients with severe MPP. We conducted a cohort study with a large sample size to evaluate the effects of adjunctive low-dose corticosteroid treatment for children with MPP, stratified by severe pneumonia, refractory pneumonia, Abbreviations: MP, Mycoplasma pneumoniae; MPP, Mycoplasma pneumoniae pneumonia; CAP, community acquired pneumonia; RCT, randomized controlled trial; MRMP, macrolide-resistant Mycoplasma pneumoniae; CRP, C-reactive protein; LDH, lactic dehydrogenase; IL, interleukin; OR, odds ratio; CI, confidence interval; ICU, intensive care unit; MSMP, macrolide-sensitive Mycoplasma pneumoniae.
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