Radiologic findings as a determinant and no effect of macrolide resistance on clinical course of Mycoplasma pneumoniae pneumonia

Abstract

BackgroundWith the emergence of macrolide resistance, concerns about the efficacy of macrolides for the treatment of Mycoplasma pneumoniae (MP) pneumonia in children have been raised. This study aimed to determine the effect of macrolide resistance on the outcome of children who were hospitalized with MP pneumonia.MethodsBetween 2010 and 2015, we performed culture of MP from nasopharyngeal samples obtained from children who were hospitalized with pneumonia at five hospitals in Korea. Macrolide resistance was determined by the analysis of 23S rRNA gene transition and the minimal inhibitory concentrations of four macrolides. Medical records were reviewed to analyze the clinical response to treatment with macrolides.ResultsMP was detected in 116 (4.8%) of the 2436 children with pneumonia. MP pneumonia was prevalent in 2011 and 2015. Of the 116 patients with MP pneumonia, 82 (70.7%) were macrolide-resistant. There were no differences in the age distribution, total duration of fever, and chest x-ray patterns between the macrolide-susceptible and macrolide-resistant groups. After macrolide initiation, mean days to defervescence were longer in the macrolide-resistant group than in macrolide-susceptible group (5.7 days vs. 4.1 days, P = 0.021). However, logistic regression analysis revealed that the presence of extrapulmonary signs (P = 0.039), homogeneous lobar consolidation (P = 0.004), or parapneumonic effusion (P < 0.001) were associated with fever duration of ≥7 days after the initiation of macrolides, regardless of macrolide resistance.ConclusionsThis study demonstrated that fever duration in MP pneumonia was determined by the radiologic findings of chest x-ray, not by the presence of macrolide resistance. The results highlight the need for future studies to assess therapeutic benefit from macrolides in the treatment of children with MP pneumonia.

Unresolved atelectasis in refractory Mycoplasma pneumoniae pneumonia: Predictive factors and the influence of corticosteroids and bronchoscopy lavage therapy

“…Macrolides are still used as rst-line agents at high frequencies in countries with a high burden of MR-MP strains, such as China and Japan, mainly because of their low minimum inhibitory concentrations against the MP, anti-in ammatory effect and low toxicity in children. Yoon et al reported macrolide treatment for macrolidesusceptible MP pneumonia did not contribute to signi cant clinical improvement compared to no antimicrobial treatment [13] . Yang et al reported corticosteroid therapy might prevent disease progression, and anti-MPantibiotics may have limited effects on MPP [1] .…”

Mycoplasma pneumoniae​ pneumonia associated thrombosis at Beijing Children’s Hospital

“…This suggests that SMPP is the most strongly associated risk factor for MPassociated thrombosis. The severity of MPP was associated with fever duration, the levels of inflammatory markers such as CRP and LDH, and the severity of radiography findings such as lobar consolidation [21][22][23][24] , which are strongly correlated with measures of the severity of airway damage such as mucous necrosis and subsequent airway remodeling [4] . The present study again confirmed the above associations, and the presence of an excessive systemic and local airway immune response in SMPP.…”

Clinical Characteristics of Macrolide-Resistant Mycoplasma pneumoniae from Children in Jeju

“…For example, in the MRMP group, the duration of fever, cough, hospitalization was longer and the rate of change to alternative antibiotics was higher than the MSMP group ( 20 21 ). However, a recent study reported that macrolide resistance alone has no effect on clinical course of M. pneumoniae pneumonia ( 22 ). In our study, the contribution of macrolide resistance on clinical course was not found like the latter report.…”