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Independent risk factors for refractory mycoplasma pneumoniae pneumonia in children: a multivariate analysis

Qi Guo1, Hui Guo2, Jie-Jie Chen3

  • 1Department of Pediatrics, Anhui Provincial Second People's Hospital, No. 1868, North Second Ring Road, Hefei City, Anhui Province, 230041, China. q4i_gg816uo@163.com.

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|July 29, 2026
PubMed
Abstract

Insights

Refractory Mycoplasma pneumoniae pneumonia (RMPP) in children is associated with higher leukocyte counts and specific inflammatory markers. Factors like elevated neutrophil-to-lymphocyte ratio (NLR) and Clinical Pulmonary Infection Score (CPIS) predict RMPP development.

Area of Science:

  • Pediatric Infectious Diseases
  • Respiratory Medicine
  • Clinical Microbiology

Background:

  • Mycoplasma pneumoniae pneumonia (MPP) is a common childhood respiratory infection.
  • Refractory MPP (RMPP) presents a significant clinical challenge due to persistent symptoms and potential complications.
  • Identifying risk factors for RMPP is crucial for timely intervention and improved patient outcomes.

Purpose of the Study:

  • To investigate the independent risk factors associated with the development of refractory Mycoplasma pneumoniae pneumonia (RMPP) in pediatric patients.
  • To compare clinical and serological indicators between children with RMPP and those with general MPP (GMPP).

Main Methods:

  • A retrospective study involving 144 RMPP cases and 161 GMPP cases treated between January 1, 2024, and June 1, 2025.
  • Comparison of clinical data and serological indicators using t-tests, chi-squared tests, and Logistic regression analysis.
  • Evaluation of predictive values for key indicators using Area Under the Curve (AUC).

Main Results:

  • Children with RMPP exhibited significantly higher leukocyte counts, C-reactive protein, D-dimer, lactate dehydrogenase, and neutrophil-to-lymphocyte ratio (NLR) compared to GMPP.
  • Independent risk factors for RMPP included Clinical Pulmonary Infection Score (CPIS), D-dimer, NLR, pulmonary rales, abnormal chest imaging, complicated infections, and positive drug-resistant gene loci.
  • NLR demonstrated the highest predictive value (AUC=0.836) for RMPP, followed by CPIS (AUC=0.700) and D-dimer (AUC=0.691).

Conclusions:

  • CPIS, D-dimer, NLR, pulmonary rales, abnormal chest imaging, complicated infections, and positive drug-resistant gene loci are significant independent risk factors for RMPP in children.
  • Vigilance for RMPP is recommended when these factors are present.
  • NLR is a highly valuable biomarker for predicting RMPP development.
Keywords:
ChildClinical FeaturesMycoplasma Pneumoniae PneumoniaRisk Factors

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