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Prevalence of Macrolide-Resistant Mycoplasma pneumoniae Infections After the COVID-19 Pandemic in Southern Italy,
Francesca Centrone1, Marisa Accogli1, Raffaella Melilli2
1Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124, Bari, Italy.
Introduction:
The COVID-19 pandemic and associated non-pharmaceutical interventions (NPIs) markedly reduced the circulation of respiratory pathogens. In late 2023, a resurgence of Mycoplasma pneumoniae (MP) infections, including macrolide-resistant strains (MRMP), was documented worldwide. This study aimed to determine MRMP prevalence and epidemiological characteristics in Southern Italy during the post-pandemic period.
Methods:
Between January 2023 and May 2025, 5362 respiratory specimens were tested for M. pneumoniae and other respiratory pathogens using multiplex real-time polymerase chain reaction (PCR). Macrolide resistance-associated mutations in the 23S rRNA gene were identified through PCR amplification and Sanger sequencing. Data were stratified by age group and clinical setting.
Results:
MP prevalence peaked at 15.8% in May 2025. Of 305 positive cases, the median age was 10 years, 52.1% were male, and 86.9% were hospitalized. Coinfections occurred in 23.3% of cases, particularly among children < 5 years. Macrolide resistance was detected in 7.5% of MP-positive samples, predominantly the A2063G mutation (96%), with the highest prevalence in patients aged 10-14 years (12.6%). No resistance was identified in ICU patients.
Conclusion:
The post-pandemic resurgence of M. pneumoniae in Southern Italy, coupled with sustained macrolide resistance, underscores the need for continuous molecular surveillance and targeted antimicrobial stewardship to optimize therapy and prevent further resistance spread.
Insights
Macrolide-resistant Mycoplasma pneumoniae (MRMP) has resurged globally post-pandemic. In Southern Italy, MRMP was detected in 7.5% of cases, highlighting the need for surveillance and stewardship.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Background:
- The COVID-19 pandemic suppressed respiratory pathogen circulation.
- A global resurgence of Mycoplasma pneumoniae (MP), including macrolide-resistant strains (MRMP), occurred in late 2023.
- This study focuses on the post-pandemic epidemiological landscape of MRMP in Southern Italy.
Purpose of the Study:
- To determine the prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP).
- To characterize the epidemiological features of MRMP infections.
- To assess MRMP in Southern Italy during the post-pandemic period.
Main Methods:
- Respiratory specimens (n=5362) were analyzed from January 2023 to May 2025.
- Multiplex real-time PCR identified M. pneumoniae and other pathogens.
- Macrolide resistance mutations were detected via PCR and Sanger sequencing, with data stratified by age and clinical setting.
Main Results:
- MP prevalence peaked at 15.8% in May 2025.
- Macrolide resistance was found in 7.5% of MP cases, primarily the A2063G mutation (96%).
- Highest resistance (12.6%) was observed in patients aged 10-14 years; no resistance was found in ICU patients.
Conclusions:
- A post-pandemic resurgence of MP in Southern Italy is confirmed.
- Sustained macrolide resistance necessitates ongoing molecular surveillance.
- Targeted antimicrobial stewardship is crucial to manage resistance and optimize therapy.
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