Meta-analysis of Macrolide Resistance Pattern of Mycoplasma pneumoniae in the World

Abstract

Background: There are increasing reports regarding macrolide resistance in Mycoplasma pneumoniae, particularly in Asia. Indiscriminate consumption of macrolide could be an alarming sign worldwide. We aimed to systematically review and analyze the prevalence and pattern of resistance in Mycoplasma pneumoniaeaccording to the recent studies.Methods: We searched authentic scienti c sources and databases, and reference lists of relevant articles from January 1, 2017, to April 1, 2022. Meta-analyses were accomplished on the extracted and evaluated epidemiological data for proportion outcome variables, which included factors associated with Macrolide resistance, A2063G and A2064G.Results: Most of the included studies were conducted in Asia (a total number of 10353 patients). Twentynine quali ed studies were included in order to evaluation of macrolide resistance. The overall pooled prevalence was 52% (38%-65%), I2=100%; p<0.001. While subgroups analyses revealed that the pooled prevalence for America (3 studies), Asia (23 studies), and Europe (3 studies) was 8% (6%-10%), 63% (52%-75%), and 4% (2%-7%), respectively.Seventeen eligible studies for determining of A2063G and 14 for A2064G were analyzed. Global pooled prevalence was 75% (68%-83%), I2=100%; p<0.001, and 4 %( 2%-5%), I2=89%; p<0.001 for A2063G and A2064G, respectively.Pooled prevalence of A2063G for America, Asia and Europe was 10% (4%-15%), 91% (88%-93%) and 5% (2%-9%), respectively. Conclusion: While the prevalence of macrolide-resistant MP is quite low in America, it is a great dilemma in East Asia and the low prevalence in most countries could be underestimated. This study revealed an increasing trend in macrolide resistance. Indiscriminate and improper use of macrolides may be a warning in this regard.