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Severe Mycoplasma pneumoniae pneumonia requiring intensive care in children, 2010-2019
Kuan-Lin Lee1, Chieh-Ming Lee2, Te-Liang Yang1
1Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Severe Mycoplasma pneumoniae pneumonia (MPP) in children is rare but life-threatening. Delayed antibiotic treatment significantly worsens outcomes in pediatric patients with severe MPP.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Critical Care Medicine
Background:
- Mycoplasma pneumoniae infections are common, but severe, life-threatening pneumonia in children (MPP) is infrequently reported.
- Understanding the characteristics and risk factors for severe MPP is crucial for timely intervention.
Purpose of the Study:
- To analyze clinical manifestations and laboratory data of pediatric patients with severe MPP requiring intensive care unit (ICU) admission.
- To investigate the relationship between macrolide resistance and clinical outcomes in severe MPP.
Main Methods:
- Retrospective enrollment of pediatric patients with PCR-positive MPP admitted to the ICU.
- Analysis of clinical data, laboratory results, and pleural fluid characteristics.
- Genotyping to determine macrolide susceptibility and correlate with clinical findings.
Main Results:
- Approximately 5% of hospitalized MPP cases required ICU admission.
- ICU patients had more comorbidities, pleural effusion, prolonged fever, and longer hospital stays.
- Delayed effective and second-line antibiotic treatments were associated with severe outcomes, including septic shock and ARDS, regardless of macrolide resistance levels.
Conclusions:
- Mycoplasma pneumoniae can cause severe, life-threatening pneumonia in children.
- Delayed administration of effective and second-line antibiotics is a key factor associated with severe MPP outcomes.
Background/Purpose:
Despite the high prevalence of Mycoplasma pneumoniae infections, reports on severe life-threatening M. pneumoniae pneumonia (MPP) in children are limited.
Methods:
We retrospectively enrolled pediatric patients with PCR-positive MPP requiring ICU admission in a children's hospital in Taipei, Taiwan from Jun 2010 to October 2019. Clinical manifestations and laboratory data of severe MPP were analyzed. Macrolide susceptibility was determined by genotyping, and its relationship with clinical manifestations was also analyzed.
Results:
Approximately 5% (34/658) children hospitalized for MPP required ICU admission. Compared with non-ICU cases (n = 291), ICU cases (n = 34) were associated with more underlying conditions, more pleural effusion, longer fever duration, longer hospital stay, the requirement of second-line antibiotic treatment, and delayed effective and second-line antibiotic treatment. Macrolide resistance was similar in ICU and non-ICU groups (53% vs 53%; p = 0.986). In severe MPP, patients requiring endotracheal intubation were associated with more septic shock, empyema, ARDS, prolonged fever after effective antibiotic treatment, delayed second-line and effective antibiotic treatment. In 18 of the 22 patients with pleural fluid analysis, the pleural effusion was alkaline (pH > 7.7) and lymphocyte-predominant.
Conclusion:
M. pneumoniae infection can cause severe life-threatening pneumonia in children. Delayed effective and second-line antibiotic treatments are associated with severe life-threatening MPP.
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