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Development of macrolide resistance in Mycoplasma pneumoniae-infected Swedish patients treated with macrolides
Anna C Nilsson1, Jørgen Skov Jensen, Per Björkman
1From the Department of Clinical Science, Infectious Disease Research Unit, Skåne University Hospital , Malmö , Sweden.
Background:
The proportion of Mycoplasma pneumoniae isolates carrying point mutations in the 23S region of the genome associated with macrolide resistance has increased. We evaluated the probability of developing M. pneumoniae macrolide resistance mutations during macrolide treatment.
Methods:
M. pneumoniae strains from initial and follow-up oropharyngeal samples from 38 Swedish patients were tested for 23S rRNA mutations by amplifying and pyrosequencing the gene target region. The duration of symptoms and of M. pneumoniae carriage were recorded in cases with and without the macrolide resistance mutation.
Results:
Macrolide resistance mutations were absent in all baseline strains. Twenty-two patients were prescribed macrolides; the longest M. pneumoniae carriage time in these patients was 7 months and the longest symptomatic period was 7.5 months. Macrolide resistance was detected after macrolide treatment in 1 patient (carriage time 3.5 months and symptomatic period 7.5 months).
Conclusions:
M. pneumoniae may develop macrolide resistance during macrolide treatment. A long duration of M. pneumoniae carriage and symptoms is common in patients regardless of the presence of resistance.
Insights
Mycoplasma pneumoniae can develop macrolide resistance mutations during treatment. Long M. pneumoniae carriage and symptom duration are common, irrespective of resistance development.
Area of Science:
- Medical microbiology
- Genetics
- Infectious diseases
Background:
- Increasing macrolide resistance in Mycoplasma pneumoniae is linked to 23S rRNA gene mutations.
- Understanding resistance development during treatment is crucial.
Purpose of the Study:
- To assess the likelihood of Mycoplasma pneumoniae developing macrolide resistance mutations during macrolide therapy.
Main Methods:
- Analyzed M. pneumoniae strains from Swedish patients using pyrosequencing for 23S rRNA mutations.
- Correlated macrolide resistance with symptom and carriage durations.
Main Results:
- No baseline macrolide resistance mutations were detected.
- One patient developed macrolide resistance after macrolide treatment (3.5 months carriage, 7.5 months symptoms).
- Prolonged carriage and symptoms occurred in patients both with and without resistance.
Conclusions:
- Mycoplasma pneumoniae can acquire macrolide resistance during macrolide treatment.
- Extended carriage and symptom duration are characteristic of M. pneumoniae infections, independent of resistance status.
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