Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Adolescents and Adults: Clinical Findings, Drug Susceptibility, and Therapeutic Efficacy

Abstract

We investigated differences in the clinical findings between 30 patients with macrolide-resistant Mycoplasma pneumoniae pneumonia and 43 patients with macrolide-sensitive M. pneumoniae pneumonia in adolescents and adults. No differences in clinical presentation were observed between the two groups. Among patients with macrolide-resistant Mycoplasma pneumoniae pneumonia, treatment was more effective in the groups that received quinolones and minocycline than in the group that received macrolides (P ‫؍‬ 0.0361 and P ‫؍‬ 0.0237, respectively). Mycoplasma pneumoniae is a major cause of community-acquired pneumonia (CAP) in school-age children and young adults (1, 2). A specific diagnosis of M. pneumoniae infection is important because treatment with routinely used ␤-lactam antibiotics is ineffective against these organisms because they lack a cell wall. Thus, the Japanese Respiratory Society (JRS) CAP guidelines have been recommended as a rapid and simple scoring system based on clinical and laboratory findings for the presumptive diagnosis of M. pneumoniae pneumonia (1,3,4). Our recent study demonstrated that the JRS scoring system was the most useful tool for initiating the administration of adequate antibiotic therapy for probable M. pneumoniae pneumonia among the rapid diagnostic methods tested (5).Although M. pneumoniae pneumonia is usually mild in severity, macrolide-resistant (MR) M. pneumoniae with mutations in the 23S rRNA gene has emerged in pediatric patients with CAP (6, 7). More than 60% of M. pneumoniae strains in pediatric patients showed high resistance to 14-and 15-membered ring macrolides with a MIC of Ն64 mg/liter (8-10). The clinical and bacteriological efficacy of macrolides for treating cases of MR M. pneumoniae pneumonia was lower than that in cases of macrolide-sensitive (MS) M. pneumoniae pneumonia in pediatric patients (9-13). In contrast to pediatric patients, the available data on MR M. pneumoniae infection in adolescent and adult patients are limited (8,14). The purpose of the present study was to identify a means of rapidly distinguishing MR M. pneumoniae pneumonia from MS M. pneumoniae pneumonia in daily clinical practice without waiting for genetic analysis results. We compared the underlying conditions, pneumonia severity, clinical symptoms, laboratory data, prognostic factors, and radiographic findings between patients with MR M. pneumoniae pneumonia and those with MS M. pneumoniae pneumonia (MR patients and MS patients, respectively) in adolescents and adults. Based on the clinical presentation, we evaluated the usefulness of rapid and simple clinical diagnostic methods (5), the JRS scoring system (1, 3, 4), and high-resolution computed tomography (HRCT) (15, 16) for the early presumptive diagnosis of M. pneumoniae pneumonia. An additional purpose of this study was to investigate the drug susceptibility of MR isolates and differences in therapeutic efficacy against MR M. pneumoniae among macrolides, quinolones, and minocycline.Adolescent and adult patients with CAP who visited 12 i...

Lactate Dehydrogenase as a Biomarker for Prediction of RefractoryMycoplasma pneumoniaePneumonia in Children

“…[18][19][20][21] Cell-mediated immunity of the host rather than direct microbial damage plays an important role in the progression of this illness. 22,23 Clinically and experimentally, steroids have a positive effect on refractory M. pneumoniae pneumonia.…”

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

“…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). In adult patients, while no differences are observed in the initial presentation of MSMP and MRMP infection, the number of patients exhibiting defervescence within 48 hours after macrolides administration is smaller among individuals with MRMP infection than among those with MSMP infection (6). Therefore, employing a rapid method to detect resistance-associated mutations is crucial in cases of persistent or refractory infection with M. pneumonia, and obtaining an early diagnosis of MRMP infection allows for a prompt shift to an alternative antimicrobial regimen that is effective against these resistant strains.…”

“…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).…”

“…While some case reports (2-4) and series (5,6,8) The optimal treatment for severe infection caused by MRMP in adults remains uncertain. Pharmacokinetics and in vitro data have indicated that tetracyclines and fluoroquinolones are potential treatment options, and our case series provided clinical evidence for the therapeutic efficacy of these drugs in adult patients with MRMP infection.…”

“…Macrolides are generally considered to be the first-line agents in the treatment of M. pneumoniae infection. The prevalence of macrolide-resistant M. pneumoniae (MRMP) infection among pediatric patients in Japan has increased rapidly (1), and several case reports (2-4) and series (5,6) of adults with CAP associated with MRMP infection have also been published. We herein report a case of CAP caused by MRMP in an adult who responded poorly to macrolides.…”