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Macrolide Resistance of Mycoplasma pneumoniae Among Children in Hangzhou: A 2024-2025 Post-Pandemic Surveillance

Xudong Xu1, Xiangyang Xiao2, Jun Zhou1

  • 1Department of Laboratory Medicine, Hangzhou Children's Hospital, Hangzhou, 310014, People's Republic of China.

Infection and Drug Resistance
|June 1, 2026
PubMed
Abstract

Insights

Post-pandemic pediatric Mycoplasma pneumoniae infections in Hangzhou show extremely high macrolide resistance, particularly in outpatients. Urgent antimicrobial stewardship is needed to combat widespread resistant strains in children.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Resistance
  • Molecular Epidemiology

Background:

  • The COVID-19 pandemic altered respiratory pathogen circulation globally.
  • A resurgence of Mycoplasma pneumoniae (MP) infections is noted post-pandemic, especially in China.
  • Macrolide resistance in MP poses a significant clinical challenge.

Purpose of the Study:

  • To investigate the epidemiological characteristics of pediatric MP infections in Hangzhou.
  • To determine the macrolide resistance profile of MP in post-pandemic pediatric cases.
  • To provide laboratory surveillance data for informed clinical management.

Main Methods:

  • Retrospective analysis of 12,380 pediatric respiratory specimens (March 2024 - December 2025).
  • Detection of MP nucleic acid and 23S rRNA resistance mutations (A2063G/A2064G) via quantitative PCR.
  • Analysis of positivity and resistance rates by demographics and care setting.

Main Results:

  • Overall MP positivity rate was 19.98%.
  • Macrolide resistance mutations were found in 86.94% of MP cases, a globally high level.
  • Outpatients showed higher resistance (92.13%) than inpatients (86.10%); resistance exceeded 78% across all ages, reaching 100% in some months.

Conclusions:

  • Pediatric MP infections in Hangzhou exhibit alarmingly high and persistent macrolide resistance post-pandemic.
  • Significantly higher resistance in outpatients suggests widespread community circulation of resistant strains.
  • Urgent need for rapid resistance testing and targeted antimicrobial stewardship in pediatric outpatient settings.
Keywords:
ChinaMycoplasma pneumoniaeantimicrobial stewardshipchildrenmacrolide resistanceoutpatient surveillancepost-COVID-19

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