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Macrolide resistance rate and antimicrobial selection in pediatric Mycoplasma pneumoniae infection during 2024
Shiho Iwase1, Taichiro Muto2, Tomoki Yamamoto2
1Department of Pediatrics, Nagoya Memorial Hospital, Nagoya, Japan; Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Introduction:
A Mycoplasma pneumoniae (MP) infection outbreak occurred in Japan in 2024. Macrolides (MLs) are first-line antibiotics for MP infections; however, ML resistance rates vary by region and time of year. In recent years, point-of-care Quenching Probe PCR (QP-PCR) assays have enabled the detection of MP and macrolide resistance mutations. We aimed to determine the impact of rapid diagnosis by QP-PCR on clinical outcomes, the ML resistance rate, and the therapeutic efficacy of MLs, minocycline (MINO) and tosufloxacin (TFLX) in pediatric patients with MP infection in 2024.
Methods:
This single-center retrospective observational study was conducted from January to December 2024. A total of 206 pediatric patients with MP infection and ML susceptibility determined by QP-PCR were included. The primary outcome was fever duration.
Results:
MLs susceptible MP (MSMP) was identified in 132 (64%) patients and MLs resistant MP (MRMP) in 74 (36%) patients. In the MSMP, the time to defervescence after the initiation of susceptible antibiotics was shorter with MLs than with TFLX (1 vs. 5 days, p < 0.001). Among patients with MRMP aged ≥8 years, it was shorter in MINO than with TFLX (1 vs. 3 days, p = 0.002). QP-PCR-guided antibiotic initiation group had a shorter total fever duration compared with the empirical antibiotic initiation followed by QP-PCR-guided antibiotic modification group (MSMP; 6 [4-7] vs. 7 [6-9] days, p < 0.001, MRMP; 5 [3-7.75] vs. 8 [5-9] days, p = 0.005).
Conclusions:
Early diagnosis using QP-PCR may contribute to shortening the duration of fever.
Insights
Rapid diagnosis of Mycoplasma pneumoniae (MP) using Quenching Probe PCR (QP-PCR) shortened fever duration in pediatric patients. This approach guided antibiotic selection, improving clinical outcomes for both macrolide-susceptible and macrolide-resistant MP infections.
Area of Science:
- Pediatric Infectious Diseases
- Molecular Diagnostics
- Antimicrobial Resistance
Background:
- A Mycoplasma pneumoniae (MP) outbreak in Japan in 2024 highlighted the need for effective treatment strategies.
- Macrolide (ML) resistance in MP varies geographically and seasonally, complicating treatment.
- Point-of-care Quenching Probe PCR (QP-PCR) assays offer rapid detection of MP and associated macrolide resistance mutations.
Purpose of the Study:
- To evaluate the impact of rapid QP-PCR diagnosis on clinical outcomes in pediatric MP infections.
- To determine the macrolide resistance rate in MP infections during the 2024 outbreak.
- To assess the therapeutic efficacy of macrolides, minocycline (MINO), and tosufloxacin (TFLX) guided by QP-PCR results.
Main Methods:
- A single-center retrospective observational study included 206 pediatric patients with MP infection.
- ML susceptibility was determined using QP-PCR.
- The primary outcome measured was fever duration.
Main Results:
- Macrolide-susceptible MP (MSMP) was found in 64% of patients, and macrolide-resistant MP (MRMP) in 36%.
- QP-PCR-guided antibiotic therapy resulted in shorter fever duration compared to empirical treatment followed by modification.
- Specific antibiotic efficacy varied: MLs were faster than TFLX for MSMP, and MINO was faster than TFLX for MRMP in patients aged ≥8 years.
Conclusions:
- Early diagnosis of MP and its macrolide resistance profile using QP-PCR can significantly shorten fever duration.
- QP-PCR-guided antibiotic selection optimizes treatment efficacy for pediatric MP infections.
- Rapid molecular diagnostics are crucial for managing MP outbreaks and antimicrobial stewardship.
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