Adult community‐acquired pneumonia caused by macrolide resistant Mycoplasma pneumoniae

Abstract

A 28-year-old woman with community-acquired pneumonia was treated with sulbactam/ampicillin and clarithromycin, but failed to show any improvement after 4 days. The antibiotic regimen was changed to pazufloxacin and rapid clinical improvement was seen. Mycoplasma pneumoniae was identified as the causative agent, and adenine (A) to guanine (G) mutation at position 2063 in domain V of the 23S rRNA was noted in the isolate. The minimum inhibitory concentration of macrolide antibiotics, including clarithromycin, of this isolate was greatly elevated.

Differences in the Frequency of 23S rRNA Gene Mutations in Mycoplasma pneumoniae between Children and Adults with Community-Acquired Pneumonia: Clinical Impact of Mutations Conferring Macrolide Resistance

“…These differences were also observed in each age group, although they did not reach statistical significance (Table 2). Reports on the clinical presentation of MRMP infections are rare in adults with pneumonia (3,10). In our series, four adult patients with MRMP were initially treated with macrolides (with or without ␤-lactam antibiotics).…”

“…Pneumonia caused by MRMP shows an increased duration of symptoms and requires a longer antibiotic treatment course compared to pneumonia caused by macrolide-susceptible M. pneumoniae (MSMP) in pediatric patients (2,8,16). Even though some findings for the frequencies of MRMP in adult patients have been reported, the clinical significance of macrolide resistance in adult pneumonia remains open for debate, since M. pneumoniae infection typically produces mild symptoms that spontaneously diminish (2,3,9,10,13). In terms of the frequencies and clinical significance of MRMP, simultaneous comparative findings between adults and children have not been reported previously.…”

Azithromycin treatment failure in macrolide-resistant Mycoplasma pneumoniae pneumonia

“…No cohort studies have been performed in an adult population. A previous case report described a 28-yr-old lady with CAP, who had persistent symptoms after clarithromycin therapy, and later responded to intravenous pazufloxacin [9]. The strain was found to carry the A-to-G transition at position 2,063.…”

Community-acquired Pneumonia Caused by Macrolide-resistant <i>Mycoplasma pneumoniae</i> in Adults

“…Although a previous report emphasized that in vitro resistance to macrolides does not necessarily equate to clinical failure, the presence of MRMP in patients with CAP may result in treatment failure (2)(3)(4)6). Treatment failure in pediatric patients with MRMP infection is evidenced by a febrile period and persistent cough of longer duration than that observed in children infected with macrolide-susceptible M. pneumonia (MSMP) (1, 7).…”