Antimicrobial Susceptibility of
            <i>Mycoplasma pneumoniae</i>
            Isolates and Molecular Analysis of Macrolide-Resistant Strains from Shanghai, China

Liu, Yang; Ye, Xinyu; Zhang, Hong; Xu, Xiaogang; Li, Wanhua; Zhu, Demei; Wang, Minggui

doi:10.1128/aac.01684-08

Cited by 120 publications

(102 citation statements)

References 17 publications

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“…No signifi cant difference was found in clinical parameters between the 9 patients with resistant and 19 patients with sensitive M. pneumoniae species (Table). Other than our propositus case, we did not observe in our sample a longer course of disease in patients with macrolide-resistant M. pneumoniae, as suggested in previous studies (6,12).…”

Section: The Studysupporting

confidence: 69%

Macrolide Resistance inMycoplasma pneumoniae, Israel, 2010

Averbuch¹,

Hidalgo-Grass²,

Moses³

et al. 2011

Emerg. Infect. Dis.

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Macrolide resistance in Mycoplasma pneumoniae is often found in Asia but is rare elsewhere. We report the emergence of macrolide-resistant M. pneumoniae in Israel and the in vivo evolution of such resistance during the treatment of a 6-year-old boy with pneumonia.M ycoplasma pneumoniae is a leading respiratory pathogen in both pediatric (1,2) and adult (1,3) populations. Macrolides are considered the fi rst line of therapy and are almost the only treatment for children. In recent years, alarming rates of M. pneumoniae with macrolide resistance (<90%) have occurred in eastern Asia, including the People's Republic of China, Japan, and Korea (2,4-7). This was initially reported in children; however, a surge of resistance in adults was recently reported (2,4,7). Macrolide-resistant M. pneumoniae has also been suggested to be associated with a longer course of disease (2,4).In the Western Hemisphere, lower rates of macrolide resistance have been reported (<10%), however, several epidemics with notable complications have occurred (8)(9)(10)(11). We report the detection of macrolide resistance in M. pneumoniae in Israel. The StudyA previously healthy 6-year-old boy was hospitalized after 2 weeks with fever up to 40°C. At onset of illness, a diagnosis of pharyngitis was made. Streptococcus pyogenes was isolated from his throat, and amoxicillin was prescribed without any clinical response. Later, a clinical diagnosis of sinusitis was made, and amoxicillin-clavulanate was prescribed. A chest radiograph done at that time reportedly showed no abnormalities. Laboratory investigation before admission showed leukocytosis of 19,600 cells/mm 3 with 2,200 monocytes/mm 3 and 7,600 neutrophils/mm 3 ; L-lactate dehydrogenase (LDH) was 1,854 U/L (reference value up to 600 U/L).Ten days after the beginning of his illness, his fever decreased for 2 days and then reappeared, together with cough, resulting in hospitalization. At admission, pneumonia of the right middle and lower lobe was confi rmed by chest radiograph. Laboratory tests showed leukocytes within normal ranges, erythrocyte sedimentation rate (ESR) 80/h, and C-reactive protein (CRP) 15 mg/L (reference range up to 0.5 mg/L). Treatment with penicillin was started without clinical improvement. Azithromycin (10 mg/kg/d) was added on the third day. After receiving this treatment, his leukocytes increased to 20,000 cells/mm 3 with ESR 97/h and CRP 22.5 mg/L. The β-lactam coverage was switched to cefuroxime and later to ceftriaxone because no response was observed. Chest ultrasound showed a small pleural effusion. Bronchoscopy showed thick mucus secretions; respiratory specimens tested were negative for respiratory syncytial virus, infl uenza viruses A and B, parainfl uenza virus, human metapneumovirus, and adenovirus, as were results of urine tests for Legionella spp. and blood tests for pneumococcal antigen and cryptococcal antigen.Throat swab specimens were collected and DNA extracted by boiling. Samples were positive for M. pneumoniae by real-time PCR based on the detection of ...

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Section: The Studysupporting

confidence: 69%

Macrolide Resistance inMycoplasma pneumoniae, Israel, 2010

Averbuch¹,

Hidalgo-Grass²,

Moses³

et al. 2011

Emerg. Infect. Dis.

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“…A recent report by Ferguson and colleagues documented the first macrolide-resistant M. pneumoniae infections in the United Kingdom in 6 of 32 (19%) patients studied (30). The rates of macrolide resistance observed in the United States and Europe contrast dramatically with those in reports from Asia where 80 to 90% of M. pneumoniae infections are resistant (6,7). Improved surveillance and monitoring are necessary to manage the threat of emerging resistance to the first-line therapy for M. pneumoniae infection in the United States.…”

Section: Discussionmentioning

confidence: 61%

“…In M. pneumoniae infections, macrolide resistance is an emerging threat worldwide, and in some parts of the world, Ͼ90% of M. pneumoniae infections are caused by resistant strains (6,7). In the United States, the incidence of infection with macrolide-resistant M. pneumoniae strains is not well defined, although the trait has been consistently reported over the past decade (8)(9)(10).…”

mentioning

confidence: 99%

Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013

2015

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Mycoplasma pneumoniae is a leading cause of respiratory infections, including community-acquired pneumonia (CAP). Currently, pathogen-specific testing is not routinely performed in the primary care setting, and the United States lacks a systematic surveillance program for M. pneumoniae. Documentation of individual cases and clusters typically occurs only when severe illness and/or failure to improve with empirical antibiotic therapy is observed. Outbreaks, some lasting for extended periods and involving a large number of cases, occur regularly. However, many more likely go unrecognized due to the lack of diagnostic testing and structured reporting. We reviewed data from 17 investigations of cases, small clusters, and outbreaks of M. pneumoniae M ycoplasma pneumoniae is a common respiratory pathogen in adults and children worldwide and is a leading cause of community-acquired pneumonia (CAP). The majority of infections are self-limiting, and empirical treatment without pathogen-specific diagnostic testing is common in the primary care setting. In fact, the current treatment guidelines do not recommend diagnostic testing for suspected CAP of atypical bacterial etiology in adults in the outpatient setting unless a change in the patient treatment regimen is anticipated (1). The recommendation to perform diagnostic testing for M. pneumoniae infection in children is classified as a weak recommendation and likely not routinely performed, in part due to a lack of available diagnostic tests in the primary care setting and at state and local public health laboratories (2). The estimates of the actual number of cases occurring annually are inexact due to the lack of systematic surveillance and reporting. Although historically noted to occur in 3-to 7-year cycles, outbreaks of M. pneumoniae are common and may last for several months as a result of the long incubation period and prolonged carriage after resolution of symptoms (3-5).Excessive or inappropriate antibiotic use provides selective pressure for the development of antimicrobial resistance. In M. pneumoniae infections, macrolide resistance is an emerging threat worldwide, and in some parts of the world, Ͼ90% of M. pneumoniae infections are caused by resistant strains (6, 7). In the United States, the incidence of infection with macrolide-resistant M. pneumoniae strains is not well defined, although the trait has been consistently reported over the past decade (8-10). Macrolide-resistant M. pneumoniae infection has been associated with increased febrile period, increased duration of persistent cough, and extended antibiotic therapy compared to macrolide-sensitive strains (11-16).Methods for molecular typing of M. pneumoniae strains have been developed, including discrimination of two major types and variants based on the sequence of the P1 adhesion molecule gene and identification of multiple types using multilocus variablenumber tandem-repeat analysis (MLVA) to examine four or five polymorphic loci. Despite development of these sophisticated typing methods, character...

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“…Resistance was most commonly attributed to a mutation in the domain V of the 23S rRNA. In a report from China, it was found that all macrolideresistant strains of M. pneumoniae harbour an A-to-G transition mutation at position 2,063 in the 23S rRNA gene [6]. The MIC of strains with the A2063G mutation is slightly lower for azithromycin (MIC90564 mg?mL ).…”

mentioning

confidence: 99%