The molecular characteristics, diagnosis, and treatment of macrolide-resistant Mycoplasma pneumoniae in children

Abstract

The purpose of this study is to review the molecular characteristics, the diagnosis, and treatment of the widespread infection of macrolide-resistant Mycoplasma pneumoniae (M. pneumoniae; MRMP) in children, thus providing a better knowledge of this infection and presenting the associated problems. Single point mutations in the V region of the 23S rRNA gene of M. pneumoniae genome are associated with macrolide resistance. P1–1, MLVA4-5-7-2, and ST3 are usually the predominated genetic types in the M. pneumoniae epidemics. The short-term two times serological IgM (or together with IgG) test in the acute stage can be used for confirmation. Combined serological testing and PCR might be a more prudent method to reduce macrolide consumption and antibiotic selective pressure in a clinical setting. Molecular methods for the detection of single-nucleotide mutations in the V region of the 23S rRNA gene can be used for the diagnosis of MRMP. The routine use of macrolide for the treatment of macrolide-sensitive Mycoplasma pneumoniae (MSMP) infections can get good effect, but the effects are limited for severe MRMP infections. Additional corticosteroids may be required for the treatment of severe MRMP infections in children in China during the era of MRMP.

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

“…The remaining 54 patients were excluded from the common mutation loci of A2063G, A2064G, A2067G, and C2617G and were considered to have NMRMP, with a macrolide resistance rate of 80.8%. This nding is consistent with those of other regional studies, in which the A2063G mutation in the V region of the 23S rRNA gene was the most common, followed by A2064G, which were associated with high levels of resistance, as evidenced by prolonged length of hospitalization, days of fever and cough, and course of antibiotics [7]. The sex composition of the children in both groups was balanced, with no signi cant differences in age, ranging from 7 months to 12 years (median, 7 years).…”

Clinical, Laboratory, and Radiographic Features Can Help Predict Mycoplasma pneumoniae Lower Respiratory Tract Infection in Children

“…Therefore, physicians often prescribe macrolides without positive microbiology results [ 33 ]. The widespread macrolide usage has led to an increase in MR Mp isolates and a parallel rise in macrolide resistance in other respiratory pathogens, observed worldwide [ 7 , 8 , 9 , 34 , 35 , 36 ]. Macrolides are primarily bacteriostatic agents that bind to specific nucleotides in domains II and/or V of 23S rRNA in the 50S bacterial ribosomal subunit, blocking protein synthesis by causing premature dissociation of peptidyl-tRNA from the ribosome [ 37 ].…”

“…Macrolides are primarily bacteriostatic agents that bind to specific nucleotides in domains II and/or V of 23S rRNA in the 50S bacterial ribosomal subunit, blocking protein synthesis by causing premature dissociation of peptidyl-tRNA from the ribosome [ 37 ]. Several studies have demonstrated that macrolide resistance in Mp results from single point mutations in various positions in 23S rRNA [ 7 , 8 , 9 , 36 ]. Over 90% of Mp isolates are now resistant to macrolides in some regions of Japan and China [ 1 , 34 ].…”

“…In Europe, prevalence is substantially lower than in Asia and varies from country to country, with very low levels of 1% in our country [ 1 , 35 , 38 ]. Even though these results are very encouraging, surveillance for macrolide resistance is crucial because mycoplasmas have high mutation rates, and such mutational events can rapidly accumulate in a population where selection is taking place [ 34 , 35 , 36 ]. Moreover, macrolide resistance was documented even during the course of treatment by comparing strains isolated before and after initiation of macrolide therapy and confirming the presence of new mutations in the latter [ 39 ].…”

“…The global spread of MR Mp is becoming an important issue when treating Mp infections. The clinical relevance of MR Mp has been debated since the interplay of disease severity and resistant strain infection has yet to be clarified [ 9 , 36 ]. The presence of MR Mp does not change the clinical or radiographic presentation of pneumonia, so it is impossible to guess in advance who may be harboring resistant organisms [ 9 , 36 ].…”