Macrolide Resistance and Its Impacts onM. PneumoniaePneumonia in Children: Comparison of Two Recent Epidemics in Korea

Abstract

PurposeThe aim of this study was to investigate the change in macrolide resistance rate in pediatric Mycoplasma pneumoniae pneumonia and to evaluate the influence of macrolide-resistant M. pneumoniae (MRMP) on the clinical course of disease, by comparing 2 recent, consecutive epidemics in Korea.MethodsA total of 250 patients with M. pneumoniae pneumonia admitted to a single tertiary hospital were enrolled in this study. Detection of MRMP was based on specific point mutations in domain V of the 23S rRNA gene. The medical records of enrolled patients were reviewed retrospectively, and the clinical courses and laboratory data were compared.ResultsThe macrolide resistance rate of M. pneumoniae was 51.1% (48/94) in the 2011 epidemic, and 87.2% (136/156) in the 2015 epidemic. All MRMP isolates had the A2063G point mutation. In comparison of 2 epidemics, the mean age of patients with M. pneumoniae pneumonia was increased, and the total febrile days and febrile days after initiation of macrolides were prolonged in the 2015 epidemic. Overall severity of MRMP or macrolide-susceptible M. pneumoniae (MSMP) pneumonia over 2 epidemics was not significantly changed. However, the proportion of patients who had a fever lasting more than 72 hours after initiation of macrolides and who received corticosteroid treatment were higher in MRMP pneumonia during 2 epidemics.ConclusionsThe macrolide resistance rate of M. pneumoniae has risen rapidly over 2 recent, consecutive epidemics, and this has been associated with a prolonged clinical course and increased use of corticosteroids to treat pediatric M. pneumoniae pneumonia.

Annual and seasonal patterns in etiologies of pediatric community-acquired pneumonia due to respiratory viruses and Mycoplasma pneumoniae requiring hospitalization in South Korea

“…Due to the high prevalence of MRMP, there are a great deal of concerns regarding second-line treatment options for MRMP, including tetracycline or fluoroquinolones [7]. Some previous studies have reported no significant differences with respect to clinical and radiologic findings between MRMP and MSMP pneumonia in children [8,9]. When combined with the results of the present and previous studies [8,13], a considerable proportion of cases of macrolide-resistant MP pneumonia might be recategorized as clinical MSMP or MLEP pneumonia.…”

“…The clinical courses of MP pneumonia have shown heterogeneous features, even in patients with the same in vitro sensitivity to macrolide results [8,9,13]. Some previous studies have shown no significant differences in clinical, laboratory, and radiologic features between children with macrolide-resistant MP pneumonia and those with MSMP pneumonia [7][8][9].…”

“…The most common causes of pediatric CAP in highincome countries, which differ according to age, are Mycoplasma pneumoniae (MP) and respiratory viruses [6]. Epidemics of MP infections are repeated on a 3-7 year cycle; the last epidemic in Korea was in 2015 [7][8][9]. After 2000, macrolide-resistant MP pneumonia rapidly emerged, especially in Asia [7].…”

Early Corticosteroid Therapy for <em>Mycoplasma pneumoniae</em> Pneumonia Irrespective of Used Antibiotics in Children

“…This study was not a comparative study for efficacy of corticosteroids because of no control group. We were unable to confirm MRMP strains, but other investigators in Korea have reported that the strains in the recent epidemic were MRMP strains [16,17,46]. We used corticosteroids prior to the definitive diagnosis of MP pneumonia.…”

Annual and seasonal patterns in etiologies of pediatric community-acquired pneumonia due to respiratory viruses and Mycoplasma pneumoniae requiring hospitalization in South Korea

“…The most common causes of pediatric CAP in high-income countries, which differ according to age, are Mycoplasma pneumoniae (MP) and respiratory viruses [6]. Epidemics of MP infections are repeated on a 3-7 year cycle; the last epidemic in Korea was in 2015 [7][8][9]. After 2000, macrolideresistant MP pneumonia rapidly emerged, especially in Asia [7].…”