Regional Differences in Prevalence of Macrolide Resistance among Pediatric <i>Mycoplasma pneumoniae</i> Infections in Hokkaido, Japan

Abstract

SUMMARY:Recently, macrolide-resistant (MR) Mycoplasma pneumonia appeared, and prevalence of macrolide resistance among M. pneumoniae infections varies by country. However, reports on regional differences in the prevalence of MR M. pneumonia within a country are scarce. In this study, 617 nasopharyngeal swab samples were collected from 617 pediatric patients, and DNA of M. pneumoniae was identified in 95 samples. In 51 of the 95 M. pneumonia positive samples, we detected the presence of mutation A2063G mutation (conferring macrolide resistance) in the 23S rRNA gene. The overall macrolide resistance rate was 53.7z, but there were regional differences: 0.0z in Muroran, 5.3z in Asahikawa, 55.3z in Sapporo, and 100.0z in Kushiro. Statistically significant pairwise differences in the prevalence of MR M. pneumoniae were observed among these cities except for the pair of Muroran and Asahikawa. After exclusion (in order to avoid the influence of macrolides) of patients who were prescribed macrolides before collection of nasopharyngeal swab samples, statistically significant differences persisted: 0.0z in Muroran, 5.6z in Asahikawa, 38.5z in Sapporo, and 100.0z in Kushiro.

The reduced prevalence of macrolide resistance inMycoplasma pneumoniaeclinical isolates from pediatric patients in Beijing in 2016

“…The peak season of MP infection was winter in our study, and there was seasonal difference for the prevalence of MP infection, it was higher during winter than that in spring (P< .05). These findings were consistent with the reports that the epidemic seasons in north of China is winter but is summer and autumn in the south of China 8,16 .…”

“…Our previous study found that 46 clinical isolates collected from 2003 to 2006 were MRMP, the rate of macrolide resistance was as high as 92% in Beijing 3 . Macrolide resistance rates were 3.5-13.2% in USA 4–5 , below 10% in Europe 6 , 50-90% in Japan 7–8 and more than 90% in China 3,9–10 .…”

Clinical features and seasonal variations in the prevalence of macrolide‐resistant Mycoplasma pneumoniae

“…In Japan, the Infectious Disease Control Law mandates that the number of M. pneumoniae pneumonia cases diagnosed at designated sentinel sites be reported weekly, although these data do not include the prevalence trends of macrolide resistance. The rate of macrolide resistance was shown to vary from 50% to 93% across the seven districts of Japan,24 as well as among areas in the same prefecture ranging from 0 to 100% (Hokkaido) 23. In this study, we employed the GENECUBE system and GENECUBE Mycoplasma detection kit for point‐of‐care molecular examinations, which can determine the presence of M. pneumoniae and MRM within only 1 hour.…”

“…Collecting the updated data of MRM determination rates among cases of M. pneumoniae infections may help to predict macrolide shown to vary from 50% to 93% across the seven districts of Japan, 24 as well as among areas in the same prefecture ranging from 0 to 100% (Hokkaido). 23 In this study, we employed the GENECUBE system and to season within the same year, which was possibly because of the change in endemic strains. 25 Therefore, determining the exact trend of prevalence of M. pneumoniae with MRM requires continuous monitoring, conducted locally throughout the year, which could be helpful for the antimicrobial stewardship in primary care settings.…”

“…22 Consistent with previous studies, our results indicated that clinical signs and symptoms were almost identical between pneumonia cases with and without MRM, 21,22 except for the macrolide prescription rate before evaluation. 23 The higher macrolide prescription rate before evaluation, observed in MRM pneumonia cases, could be explained by the poor clinical response to the initial treatment, which may contribute to increased hospital visits.…”