Abstract：Objective To study the clinical features of macrolide-resistant Mycoplasma pneumoniae pneumonia and its treatment regimens in children.Methods The samples of throat swab or bronchoalveolar lavage fluid were collected from 136 children with Mycoplasma pneumoniae pneumonia. Quantitative real-time PCR was used to detect 2063/2064 A:G mutation in 23S rRNA, and according to such results, the children were divided into drug-resistance group with 81 children and sensitive group with 55 children. The two groups were compared in terms of age composition, respiratory symptoms, extrapulmonary complications, laboratory markers, imaging changes, treatment regimens, and length of hospital stay.Results Compared with the sensitive group, the drug-resistance group had significantly longer duration of pyrexia and severe fever, a significantly higher percentage of children with reduced blood oxygen saturation, and significantly higher levels of alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) (P < 0.05). The conventional azithromycin treatment had a good clinical effect in the sensitive group, while corticosteroid therapy was usually needed in the drug-resistance group.Conclusions Macrolide-resistant Mycoplasma pneumoniae infection cannot be identified based on a single clinical feature, but prolonged duration of pyrexia and severe fever, reduced blood oxygen saturation, and increased ALT and LDH can suggest the presence of this disease. Azithromycin combined with glucocorticoids may be a good treatment regimen for children with macrolide-resistant Mycoplasma pneumoniae pneumonia.
CHEN Yu,TIAN Wei-Min,CHEN Qi et al. Clinical features and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children[J]. CJCP, 2018, 20(8): 629-634.
Yamazaki T, Kenri T. Epidemiology of Mycoplasma pneumoniae infections in Japan and therapeutic strategies for macrolide-resistant M. pneumoniae[J]. Front Microbiol, 2016, 7:693.
[3]
Lucier TS, Heitzman K, Liu SK, et al. Transition mutations in the 23S rRNA of erythromycin-resistant isolates of Mycoplasma pneumoniae[J]. Antimicrob Agents Chemother, 1995, 39(12):2770-2773.
[4]
Okazaki N, Narita M, Yamada S, et al. Characteristics of macrolide-resistant Mycoplasma pneumoniae strains isolated from patients and induced with erythromycin in vitro[J]. Microbiol Immunol, 2001, 45(8):617-620.
Ma Z, Zheng Y, Deng J, et al. Characterization of macrolide resistance of Mycoplasma pneumoniae in children in Shenzhen, China[J]. Pediatr Pulmonol, 2014, 49(7):695-700.
[15]
Zhou Y, Zhang Y, Sheng Y, et al. More complications occur in macrolide-resistant than in macrolide-sensitive Mycoplasma pneumoniae pneumonia[J]. Antimicrob Agents Chemother, 2014, 58(2):1034-1038.
[16]
Kim YJ, Shin KS, Lee KH, et al. Clinical characteristics of macrolide-resistant Mycoplasma pneumoniae from children in Jeju[J]. J Korean Med Sci, 2017, 32(10):1642-1646.
[17]
Lee E, Cho HJ, Hong SJ, et al. Prevalence and clinical manifestations of macrolide resistant Mycoplasma pneumoniae pneumonia in Korean children[J]. Korean J Pediatr, 2017, 60(5):151-157.
[18]
Yoon IA, Hong KB, Lee HJ, et al. Radiologic findings as a determinant and no effect of macrolide resistance on clinical course of Mycoplasma pneumoniae pneumonia[J]. BMC Infect Dis, 2017, 17(1):402.
[19]
Komatsu H, Tsunoda T, Inui A, et al. Characteristics of hospitalized children infected with macrolide-resistant Mycoplasma pneumoniae[J]. Braz J Infect Dis, 2014, 18(3):294-299.
[20]
Matsubara K, Morozumi M, Okada T, et al. A comparative clinical study of macrolide-sensitive and macrolide-resistant Mycoplasma pneumoniae infections in pediatric patients[J]. J Infect Chemother, 2009, 15(6):380-383.
[21]
Narita M, Tanaka H. Late increase of interleukin-18 levels in blood during Mycoplasma pneumoniae pneumonia[J]. Cytokine, 2012, 59(1):18-19.
Narita M. Classification of extrapulmonary manifestations due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis[J]. Front Microbiol, 2016, 7:23.
[25]
Yang D, Chen L, Chen Z. The timing of azithromycin treatment is not associated with the clinical prognosis of childhood Mycoplasma pneumoniae pneumonia in high macrolide-resistant prevalence settings[J]. PLoS One, 2018, 13(1):e0191951.
[26]
Luo Z, Luo J, Liu E, et al. Effects of prednisolone on refractory mycoplasma pneumoniae pneumonia in children[J]. Pediatr Pulmonol, 2014, 49(4):377-380.
[27]
Lee KY, Lee HS, Hong JH, et al. Role of prednisolone treatment in severe Mycoplasma pneumoniae pneumonia in children[J]. Pediatr Pulmonol, 2006, 41(3):263-268.
Ahluwalia J, Wan J, Lee DH, et al. Mycoplasma-associated Stevens-johnson syndrome in children:retrospective review of patients managed with or without intravenous immunoglobulin, systemic corticosteroids, or a combination of therapies[J]. Pediatr Dermatol, 2014, 31(6):664-669.
