Predictive Factors of the Responses to Treatment of Mycoplasma pneumoniae Pneumonia.

Yun Young Lee,Eun Lee

doi:10.3390/jcm10061154

Abstract

The prevalence of refractory Mycoplasma pneumoniae (MP) pneumonia is increasing. The present study aimed to identify the predictive factors of responses to treatment of MP pneumonia in children. A total of 149 children were diagnosed with MP pneumonia, of whom 56 were included in the good response group, 75 children in the slow response group, and 18 children in no response or progression group. Data on the clinical, laboratory, and radiologic features were retrospectively obtained through medical chart reviews. The severity of pneumonia, based on the extent of pneumonic lesions on chest x-ray (adjusted odds ratio (aOR), 10.573; 95% confidence intervals (CIs), 2.303−48.543), and lactate dehydrogenase (LDH) levels (aOR, 1.002; 95% CIs, 1.000–1.004) at the time of admission were associated with slow response to treatment of MP pneumonia. Pleural effusion (aOR, 5.127; 95% CIs, 1.404–18.727), respiratory virus co-infection (aOR, 4.354; 95% CIs, 1.374–13.800), and higher LDH levels (aOR, 1.005; 95% CIs, 1.002–1.007) as well as MP-specific IgM titer (aOR, 1.309; 95% CIs, 1.095–1.564) were associated with no response or progression of MP pneumonia. The area under the curve for the prediction of no or poor response in MP pneumonia using pleural effusion, respiratory virus co-infection, LDH levels, and MP-specific IgM titer at the time of admission was 0.8547. This study identified the predictive factors of responses to treatment of MP pneumonia in children, which would be helpful in establishing a therapeutic plan and predicting the clinical course of MP pneumonia in children.

Highlights

Mycoplasma pneumoniae (MP) is one of the most common causes of community-acquired pneumonia in children, with its cyclic epidemics occurring every three to four years, depending on the geographic location [1,2]
This study identified the predictive factors of responses to treatment of MP pneumonia in children, which would be helpful in establishing a therapeutic plan and predicting the clinical course of MP pneumonia in children
More severe pneumonic involvement and higher lactate dehydrogenase (LDH) levels at the time of admission were significantly associated with a slow response to the stepwise treatment of MP pneumonia, with the good response group considered as the reference group

Summary

Introduction

Mycoplasma pneumoniae (MP) is one of the most common causes of community-acquired pneumonia in children, with its cyclic epidemics occurring every three to four years, depending on the geographic location [1,2]. MP infection is considered to be a self-limiting disease in some cases, potentially severe MP pneumonia cases, characterized by poor response to the first-line therapy—which consists of a 7- to 14-day treatment of clarithromycin (10–15 mg/kg/day, 2–3 doses, orally) or a three-day treatment of azithromycin (10 mg/kg/day, once daily, orally)—and incomplete resolution of pulmonary lesions, are increasing [3]. With the increasing prevalence of macrolide-resistant MP and severe MP pneumonia [4], concerns regarding the prediction of the clinical course, treatment responses, and therapeutic strategies for MP pneumonia have been consistently raised [4,5].

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