Sequence Type Changes Associated with Decreasing Macrolide-Resistant Mycoplasma pneumoniae, Japan

Abstract

M ycoplasma pneumoniae is a major cause of community-acquired pneumonia, and macrolideresistant M. pneumoniae is a serious concern in Asia (1-3). Throughout Japan, an outbreak of macrolideresistant M. pneumoniae infection occurred during 2011-2012 (2). After this outbreak, the number of drug-resistant strains decreased for every year from 2013 through 2019. In contrast, China and South Korea still showed a high rate of macrolide resistance in M. pneumoniae during 2014-2018 (1,3). We determined antimicrobial drug susceptibility and performed analysis by using multilocus sequence typing (MLST), clonal complexes (CCs), and P1 gene typing for M. pneumoniae isolated from children to identify trends concerning this bacterium in Japan. The Study We obtained nasopharyngeal swab samples from patients who had pneumonia or bronchitis at 21 medical institutions throughout Japan during October 2018-July 2019. We collected samples after obtaining informed consent from patients or their family members (Ethics Committee approval no. 2016-0015,

Increased Macrolide Resistance Rate of M3562 Mycoplasma pneumoniae Correlated With Macrolide Usage and Genotype Shifting

“…It is well known that macrolide resistance rates have remained high in Asia, such as in South Korea ( Lee et al., 2018 ). However, the incidence of macrolide-resistant MP strains has drastically decreased in Japan in recent years ( Morozumi et al., 2020 ). The rate of macrolide resistance was quite low in European countries (1-19%) ( Uldum et al., 2010 ; Cardinale et al., 2013 ; Ferguson et al., 2013 ; Pereyre et al., 2013 ; Kogoj et al., 2015 ) and in the United States (8.3-10%) ( Diaz et al., 2015 ; Xiao et al., 2020 ).…”

“…Likewise, Japan has witnessed an upsurge in MP strains of the M3562 type since 2011, while MRMP rates of this type were relatively low compared with those reported in China ( Suzuki et al., 2017 ). Clearly, macrolide prescription became more strict in Japan after the publication of the guidelines for MPP treatment in 2011, which may have contributed to the current low rate of MRMP ( Morozumi et al., 2020 ). Taken together, we can conclude that antimicrobial application was a key factor in the development of MRMP.…”

“…However, macrolide-resistant MP (MRMP) strains have emerged since 2000 and are increasing rapidly worldwide, with high rates of resistance of approximately 80-90% witnessed in Asia, especially in China and Japan ( Zhao et al., 2012 ; Kawai et al., 2013 ). Notably, Japan witnessed a remarkable reduction in macrolide resistance after 2011-2012 when an outbreak of MP infection was observed ( Okada et al., 2012 ), and the MRMP rates even dropped to 11.3% during 2018-2019 ( Morozumi et al., 2020 ). In contrast, the proportion of MRMP was maintained at a high level during 2013-2018 in China ( Xue et al., 2018 ; Yan et al., 2019 ; Zhao et al., 2019 ).…”

Integrating the Human and Animal Sides of Mycoplasmas Resistance to Antimicrobials

“…In Japan, a constant increase in macrolide resistance rates was then reported until 2011, reaching 30% in 2006, 60% in 2009 and around 90% in 2010-2011, with regional rate differences [66]. A decrease in macrolide-resistant strains down to 11% was recently reported in this country [116]. This change was associated with a decrease in macrolide consumption and possibly with a shift in the prevalent genotype of M. pneumoniae, from the macrolide-resistant adhesin P1 type 1 before 2011 to the adhesin P1 type 2 harboring no macrolide resistance-associated mutations [117].…”

Update on the Epidemiology of Macrolide-Resistant Mycoplasma pneumoniae in Europe: A Systematic Review

“…In recent years, however, there has been marked reduction in the incidence of MR-MP in Japan [ 46 ]. This reduction was registered after the 2011–2012 outbreak [ 47 ]; indeed, MR-MP rates dropped to 11.3% during the 2018–2019 period [ 48 ]. By contrast, high levels of MR-MP were maintained in China during the 2013–2018 period [ 49 , 50 ].…”