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Published on: February 24, 2023
Targeted next-generation sequencing reveals pathogen mono- and co-detection patterns in pediatric Mycoplasma
Genfeng Wu1, Yuejie Zheng2, Kangyan Yuan3
1Longgang District Matermity & Child Healthcare Hospital of Shenzhen City (Afiliated Shenzhen Women and Children's Hospital (Longgang) of Shantou Wniversity Medical College, Shenzhen, Guangdong 518000, China.
Background:
Following pandemic control optimization, Mycoplasma pneumoniae (MP) has emerged as a predominant pediatric respiratory pathogen in Shenzhen. Understanding its epidemiological patterns and drug resistance is critical for managing severe MP-associated pneumonia.
Methods:
This retrospective study analyzed 607 hospitalized children (February-November 2023) using targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid. MP-positive cases were stratified by age, gender, clinical features, drug resistance genes, and co-detection profiles.
Results:
Pathogens were identified in 605 cases (99.7 %), with MP constituting 85.0 % of detected pathogens. Among 209 cases with resistance genes, A2063G mutation predominated (98.1 %). Patients were categorized into: MP-positive (n = 444), MP-carriage (n = 72), and MP-negative (n = 91) groups. Age stratification revealed significantly older MP-positive patients (median 72 months, IQR 48-96) versus carriages (29.5 months, IQR 14-60) and negatives (36 months, IQR 16-60) (P < 0.001). Gender distribution showed no significant intergroup differences (χ2 = 2.619, p = 0.270). The MP-positive group demonstrated lower co-detection rates of Haemophilus influenzae (12.2 % vs 37.5 %/31.5 %) and Moraxella catarrhalis (10.6 % vs 25.0 %/20.2 %) compared to carriages and negatives (P < 0.001). tNGS uncovered atypical pathogens including Tropheryma whipplei (13.3 %) and Fusobacterium nucleatum (6.3 %).
Conclusion:
Post-pandemic MP resurgence correlates with increased severe pediatric pneumonia despite declining macrolide resistance rates (23.2 % in 2023 vs historical 80-90 %). MP primarily manifests as monoinfections, while M. catarrhalis and H. influenzae co-detection may confer observed co-detection pattern. These findings underscore tNGS's clinical utility in identifying atypical pathogens and guiding antimicrobial stewardship in pediatric pneumonia management.
Insights
Mycoplasma pneumoniae (MP) is a leading cause of pediatric pneumonia post-pandemic. Targeted next-generation sequencing (tNGS) identified MP in 85% of cases, revealing lower macrolide resistance and aiding in diagnosing atypical pathogens.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Respiratory Medicine
Background:
- Mycoplasma pneumoniae (MP) has become a primary pediatric respiratory pathogen in Shenzhen following pandemic control measures.
- Understanding MP epidemiology and drug resistance is crucial for managing severe MP-associated pneumonia.
Purpose of the Study:
- To investigate the epidemiological patterns and drug resistance of Mycoplasma pneumoniae in hospitalized children.
- To assess the utility of targeted next-generation sequencing (tNGS) in identifying pathogens and co-infections in pediatric pneumonia.
Main Methods:
- A retrospective analysis of 607 hospitalized children from February to November 2023.
- Bronchoalveolar lavage fluid was analyzed using targeted next-generation sequencing (tNGS).
- MP-positive cases were stratified by age, gender, clinical features, drug resistance genes, and co-detection profiles.
Main Results:
- MP was detected in 85.0% of identified pathogens, with the A2063G mutation being the predominant resistance gene (98.1%).
- MP-positive patients were significantly older than MP-carriage or MP-negative groups.
- MP-positive cases showed lower co-detection rates of Haemophilus influenzae and Moraxella catarrhalis; tNGS also identified atypical pathogens like Tropheryma whipplei.
Conclusions:
- The resurgence of MP is linked to increased severe pediatric pneumonia, despite a decrease in macrolide resistance rates.
- MP often presents as a monoinfection, with co-detection patterns potentially influenced by M. catarrhalis and H. influenzae.
- tNGS is valuable for identifying atypical pathogens and guiding antimicrobial stewardship in pediatric pneumonia management.
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