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Analysis of Clinical Characteristics and Risk Factors of Pediatric Macrolide-Resistant Mycoplasma pneumoniae

Luoman Yan1, Haiyan Zhang1,2, Hengheng Fu1

  • 1Department of Pediatrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People's Republic of China.

Infection and Drug Resistance
|August 6, 2026
PubMed
Abstract

Insights

Re-emerging Mycoplasma pneumoniae (MP) with high macrolide resistance is challenging pediatric care. Macrolide-resistant MP pneumonia (MRMPP) cases showed shorter illness duration but required more alternative treatments.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Resistance
  • Respiratory Medicine

Background:

  • Re-emerging Mycoplasma pneumoniae (MP) strains exhibit high macrolide resistance, posing a significant challenge to pediatric healthcare.
  • Macrolide resistance in MP has been increasing, necessitating a deeper understanding of its clinical implications in pediatric pneumonia.

Purpose of the Study:

  • To investigate the clinical characteristics and outcomes of pediatric patients with Mycoplasma pneumoniae pneumonia (MPP) in the context of rising macrolide resistance.
  • To identify risk factors associated with macrolide-resistant MPP (MRMPP) and assess its impact on disease severity.

Main Methods:

  • Retrospective analysis of 310 children hospitalized with MPP between 2023 and 2025.
  • Comparison of clinical data, treatment regimens, and outcomes between macrolide-susceptible MPP (MSMPP) and MRMPP patients.
  • Assessment of macrolide resistance gene positivity rates over the study period.

Main Results:

  • MRMPP patients experienced shorter fever duration (5 vs 7 days) and hospital stays (9 vs 11 days) compared to MSMPP patients.
  • Higher rates of alternative antibiotic use and glucocorticoid administration were observed in MRMPP cases.
  • Elevated white blood cell counts, increased pulmonary consolidation, and higher rates of tracheal occlusion were noted in MRMPP patients, though resistance genes were not significantly linked to severe MPP.
  • Independent risk factors for MRMPP included albumin levels, pulmonary consolidation, and tracheal occlusion.

Conclusions:

  • While MRMPP may present with shorter acute symptoms, it necessitates alternative treatment strategies and is associated with specific radiological findings.
  • The interpretation of resistance mutations should be integrated with clinical and radiological assessments for effective management of pediatric MPP.
  • Further research is needed to clarify the precise role of resistant MP strains in severe pediatric disease progression.
Keywords:
clinical featuresmacrolide-resistant Mycoplasma pneumoniaepediatricsrisk factors

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