Prevalence of Genomic Resistance to Macrolide in Mycoplasma Isolates among Children with Community Acquired Pneumonia

Abstract

Introduction: Mycoplasma pneumonia is traditionally susceptible to macrolides, tetracycline and fluroquinolones. Since, tetracycline and fluoroquinolone are used cautiously in children, macrolides remain the antibiotic of choice for treating Mycoplasma pneumonia. But, resistance to macrolides has been reported in mycoplasma since the 2000s especially from Asia. Currently, there is no evidence on macrolide resistance of mycoplasma pneumoniae from India. Aim: To identify the prevalence of genomic resistance to macrolides in mycoplasma isolates among children hospitalised with community acquired pneumonia. Materials and Methods: This descriptive cross-sectional study was conducted in Department of Paediatrics at Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India (tertiary care centre for children in South India), from September 2019 to August 2020. Children between 2 months to 12 years of age, who were hospitalised with community acquired pneumonia were included in the study. The sampling procedure used was induced sputum or mini bronchoalveolar lavage (in intubated children). The samples were processed for culture in Pleuropneumonia Like Organisms (PPLO) agar. The culture isolates showing the typical fried egg colonies were subjected to polymerase chain reaction to detect the presence of resistance conferring mutation in the P1 adhesin gene MPN141. Chi-square test was used to test statistical significance. Results: Among the 268 children included in the study, mycoplasma pneumonia was positive in 33 (12.3%) cases. Mycoplasma pneumoniae was most common in children aged 1-5 years old (51.5%), followed by infants (36.4%) and children aged 5-12 (12.1%). There was no significant difference in distribution among males (39.4%) and females (60.6%) (p-value=0.08). None of the mycoplasma isolates in the study showed mutation for resistance conferring genes. Conclusion: Macrolide resistance conferring genes were not identified in the study population, which may indicate that the mycoplasma strains from this part of India are still susceptible to macrolides.