Abstract
ObjectiveTo identify patients with Mycoplasma pneumoniae pneumonia (MPP) with a risk of prolonged fever while on macrolides.MethodsA retrospective study was performed with 716 children admitted for MPP. Refractory MPP (RMPP-3) was defined as fever persisting for > 72 h without improvement in clinical and radiologic findings after macrolide antibiotics (RMPP-3) or when fever persisted for > 120 h (RMPP-5) without improvement in clinical and radiologic findings. Radiological data, laboratory data, and fever profiles were compared between the RMPP and non-RMPP groups. Fever profiles included the highest temperature, lowest temperature, and frequency of fever. Prediction models for RMPP were created using the logistic regression method and deep neural network. Their predictive values were compared using receiver operating characteristic curves.ResultsOverall, 716 patients were randomly divided into two groups: training and test cohorts for both RMPP-3 and RMPP-5. For the prediction of RMPP-3, a conventional logistic model with radiologic grouping showed increased sensitivity (63.3%) than the model using laboratory values. Adding laboratory values in the prediction model using radiologic grouping did not contribute to a meaningful increase in sensitivity (64.6%). For the prediction of RMPP-5, laboratory values or radiologic grouping showed lower sensitivities ranging from 12.9 to 16.1%. However, prediction models using predefined fever profiles showed significantly increased sensitivity for predicting RMPP-5, and neural network models using 12 sequential fever data showed a greatly increased sensitivity (64.5%).ConclusionRMPP-5 could not be effectively predicted using initial laboratory and radiologic data, which were previously reported to be predictive. Further studies using advanced mathematical models, based on large-sized easily accessible clinical data, are anticipated for predicting RMPP.
Highlights
Mycoplasma pneumoniae (MP) infections are generally mild and self-limiting
Sixty-five patients (13.0%) in the training cohort and 31 patients (14.4%) in the test cohort were classified as Refractory MPP (RMPP)-5
Our prediction model created using the C-reactive protein (CRP) level of the training cohort showed a sensitivity of 32.9% for the prediction of RMPP-3 in the test cohort even when it was combined with the lactate dehydrogenase (LDH) level (Table 5)
Summary
Mycoplasma pneumoniae (MP) infections are generally mild and self-limiting. Macrolide antibiotics have been generally preferred as the first-choice agents for MP infections because secondary antibiotics such as tetracyclines and fluoroquinolones are not recommended because of the risk of severe adverse events, especially in pediatric patients. Macrolides could be continued in cases of mild to moderate infections irrespective of their resistance, replacement by alternative antibiotics or additional corticosteroids have been shown to improve radiological abnormalities and clinical symptoms[8, 9]. The severity of the disease is partially related to the degree to which the host immune response reacts to infection. The concept of immune-mediated lung disease provides a basis for consideration of immunomodulatory therapy in addition to conventional antimicrobial therapies for the management of MP infections [10]
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