Optimization strategy for the early timing of bronchoalveolar lavage treatment for children with severe mycoplasma pneumoniae pneumonia

Abstract

Background Early evaluation of severe mycoplasma pneumoniae pneumonia (SMPP) and the prompt utilization of fiberoptic bronchoscopic manipulation can effectively alleviate complications and restrict the progression of sequelae. This study aim to establish a nomogram forecasting model for SMPP in children and explore an optimal early therapeutic bronchoalveolar lavage (TBAL) treatment strategy. Methods This retrospective study included children with mycoplasma pneumoniae pneumonia (MPP) from January 2019 to December 2021. Multivariate logistic regression analysis was used to screen independent risk factors for SMPP and establish a nomogram model. The bootstrap method was employed and a receiver operator characteristic (ROC) curve was drawn to evaluate the accuracy and robustness of the model. Kaplan–Meier analysis was used to assess the effect of lavage and hospitalization times. Results A total of 244 cases were enrolled in the study, among whom 68 with SMPP and 176 with non-SMPP (NSMPP). A prediction model with five independent risk factors: left upper lobe computed tomography (CT) score, sequential organ failure assessment (SOFA) score, acute physiology and chronic health assessment (APACHE) II score, bronchitis score (BS), and c-reactive protein (CRP) was established based on the multivariate logistic regression analysis. The ROC curve of the prediction model showed the area under ROC curve (AUC) was 0.985 (95% confidence interval (CI) 0.972–0.997). The Hosmer–Lemeshow goodness-of-fit test results showed that the nomogram model predicted the risk of SMPP well (χ2 = 2.127, P = 0.977). The log-rank result suggested that an early BAL treatment could shorten MPP hospitalization time (P = 0.0057). Conclusion This nomogram model, based on the left upper lobe CT score, SOFA score, APACHE II score, BS, and CRP level, represents a valuable tool to predict the risk of SMPP in children and optimize the timing of TBAL.

Predictive value of bronchoscopy combined with CT score for refractory mycoplasma pneumoniae pneumonia in children

“…Mycoplasma pneumoniae pneumonia (MPP) is notably prevalent in paediatric wards, accounting for approximately 10–40% of paediatric community-acquired pneumonia pathogens [ 1 ]. This condition can cause not only respiratory tract infections but also lead to extrapulmonary manifestations, such as myocardial damage, Stevens–Johnson syndrome, encephalitis, and liver damage [ 2 , 3 ]. More concerning is that mycoplasma pneumoniae (MP) can result in refractory mycoplasma pneumoniae pneumonia (RMPP).…”

Clinical characteristics and logistic regression analysis of 227 cases of children with macrolide-resistant Mycoplasma pneumoniae pneumonia

“…Some children with solid lung lesions and bronchial plastination were treated with beroptic bronchoscopy; however, the microscopic diagnosis rates did not differ signi cantly between the two groups (Table 4). Wu et al showed that timely beroptic bronchoscopy is effective in reducing complications and sequelae [17]. Early re nement of beroptic bronchoscopy and the removal of bronchial plastination are effective treatment options [18].…”

Pulmonary siderosis complicated with severe mycoplasma pneumoniae pneumonia: A case report

“…The reported incidence of SMPP has been increasing in China over the past decade [ 11 ]. Early assessment of SMPP and timely application of bronchoscopy can effectively alleviate complications and limit sequelae progression [ 12 ]. FOB and BAL can rapidly detect pathogens and identify drug-resistance genes, which are conducive to the precise treatment of severe infections [ 3 ] and reduce the irrational use of antibiotics [ 10 ].…”