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Published on: February 24, 2023
Emerging macrolide resistance in Mycoplasma pneumoniae in children: detection and characterization of resistant
Xiao Li1, T Prescott Atkinson, James Hagood
1Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA.
Background:
Epidemiologic data from Asia have documented the rapid and extensive emergence of macrolide resistance in Mycoplasma pneumoniae. This drug resistance has also been documented in Europe and recently in the United States, but there is very little information currently available on its prevalence. A rapid technique to identify macrolide-resistant M. pneumoniae is needed to guide management of patients with community-acquired respiratory infections.
Methods:
Culture and Minimum Inhibitory Concentration testing identified macrolide-resistant M. pneumoniae infection in 2 seriously ill hospitalized children with community-acquired pneumonia. A portion of the 23S ribosomal RNA gene from 2 macrolide-resistant M. pneumoniae isolates from these children as well as 4 laboratory-induced macrolide-resistant strains was amplified by PCR, and the PCR products were sequenced to identify mutations associated with macrolide resistance. A real-time PCR assay was designed to identify 3 known mutations in the 23S rRNA gene associated with macrolide resistance and applied to the clinical specimens from which these isolates were obtained and to the bacterial isolates.
Results:
: Macrolide-resistant M. pneumoniae from both children were found to carry an A2063G transition in the 23S rRNA gene previously identified in resistant isolates from China, Japan, France, and recently in an encephalitis outbreak in Rhode Island. Three laboratory-induced mutant strains had an A2064G mutation whereas the other one had an A2063G mutation. A real-time PCR assay successfully detected the macrolide-resistant M. pneumoniae directly in clinical specimens and discriminated them from wild-type isolates.
Conclusions:
Macrolide-resistant M. pneumoniae can be associated with prolonged severe respiratory infection in children. Real-time PCR offers a rapid method of diagnosing macrolide resistance in community-acquired respiratory infections due to M. pneumoniae.
Insights
Macrolide-resistant Mycoplasma pneumoniae causes severe pneumonia in children. A new real-time PCR assay rapidly detects this resistance, aiding in timely patient management.
Area of Science:
- Microbiology
- Molecular Biology
- Infectious Diseases
Background:
- Macrolide resistance in Mycoplasma pneumoniae is a growing global concern, particularly in Asia, Europe, and the US.
- Limited data exists on the prevalence of macrolide-resistant M. pneumoniae in the United States.
- Rapid diagnostic methods are crucial for managing community-acquired respiratory infections caused by M. pneumoniae.
Observation:
- Macrolide-resistant M. pneumoniae was identified in two seriously ill children with community-acquired pneumonia.
- Genetic sequencing of resistant isolates revealed specific mutations (A2063G and A2064G) in the 23S rRNA gene.
Findings:
- The real-time PCR assay successfully detected macrolide-resistant M. pneumoniae directly in clinical specimens.
- The assay could differentiate resistant strains from wild-type isolates.
- Identified mutations (A2063G) in pediatric cases matched those found in international outbreaks.
Implications:
- Macrolide-resistant M. pneumoniae infections can lead to prolonged and severe respiratory illness in children.
- Real-time PCR provides a rapid and effective diagnostic tool for identifying macrolide resistance in M. pneumoniae.
- This rapid detection can guide clinical decisions and improve patient outcomes for respiratory infections.
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