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Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter

Yun Jung Choi1,2, Eun Hee Chung3, Eun Lee4

  • 1Hospital Medicine Center, Seoul National University Hospital, Seoul KS013, Korea.

Journal of Clinical Medicine
|January 21, 2022
PubMed

Insights

Macrolide-resistant Mycoplasma pneumoniae pneumonia (MrMP) in children presents with more severe symptoms and radiographic findings than sensitive cases. Early identification is crucial, as MrMP requires alternative treatments beyond macrolides.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Pulmonology

Background:

  • Macrolides are the primary treatment for Mycoplasma pneumoniae pneumonia in children.
  • Emerging macrolide resistance in M. pneumoniae leads to treatment failures.
  • Distinguishing macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is clinically important but challenging at admission.

Purpose of the Study:

  • To identify and compare the clinical and radiographic characteristics of MrMP versus MSMP in Korean children.
  • To aid in the early discrimination of MrMP for timely and appropriate management.

Main Methods:

  • A multicenter retrospective study involving 5294 children hospitalized with M. pneumoniae pneumonia from 2010 to 2015.
  • Analysis of medical records by pediatric pulmonologists, comparing MrMP and MSMP groups.
  • Statistical analysis using one-way ANOVA and Kruskal-Wallis tests to identify significant differences.

Main Results:

  • MrMP cases (4.5%) exhibited longer fever duration, higher rates of respiratory distress, pleural effusion, and lobar pneumonia compared to MSMP.
  • Elevated AST, ALT, LDH, and CRP levels were observed in the MrMP group.
  • MrMP patients showed increased incidences of extrapulmonary manifestations and atelectasis.

Conclusions:

  • MrMP is associated with more severe initial radiographic findings and clinical courses than MSMP.
  • Prompt management of MrMP with non-macrolide agents is recommended.
  • This study highlights key differences to guide clinical decision-making in pediatric M. pneumoniae pneumonia.
Keywords:
Mycoplasma pneumoniae pneumoniachildrenmacrolide refractory Mycoplasma pneumoniae pneumonia

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