Predictive Factors of the Responses to Treatment of Mycoplasma pneumoniae Pneumonia

Abstract

The prevalence of refractory Mycoplasma pneumoniae (MP) pneumonia is increasing. The present study aimed to identify the predictive factors of responses to treatment of MP pneumonia in children. A total of 149 children were diagnosed with MP pneumonia, of whom 56 were included in the good response group, 75 children in the slow response group, and 18 children in no response or progression group. Data on the clinical, laboratory, and radiologic features were retrospectively obtained through medical chart reviews. The severity of pneumonia, based on the extent of pneumonic lesions on chest x-ray (adjusted odds ratio (aOR), 10.573; 95% confidence intervals (CIs), 2.303−48.543), and lactate dehydrogenase (LDH) levels (aOR, 1.002; 95% CIs, 1.000–1.004) at the time of admission were associated with slow response to treatment of MP pneumonia. Pleural effusion (aOR, 5.127; 95% CIs, 1.404–18.727), respiratory virus co-infection (aOR, 4.354; 95% CIs, 1.374–13.800), and higher LDH levels (aOR, 1.005; 95% CIs, 1.002–1.007) as well as MP-specific IgM titer (aOR, 1.309; 95% CIs, 1.095–1.564) were associated with no response or progression of MP pneumonia. The area under the curve for the prediction of no or poor response in MP pneumonia using pleural effusion, respiratory virus co-infection, LDH levels, and MP-specific IgM titer at the time of admission was 0.8547. This study identified the predictive factors of responses to treatment of MP pneumonia in children, which would be helpful in establishing a therapeutic plan and predicting the clinical course of MP pneumonia in children.

Analysis of Clinical Characteristics and Risk Factors of Plastic Bronchitis in Children With Mycoplasma pneumoniae Pneumonia

“…An increased LDH level can reflect the degree of tissue damage and lysis. Lee et al ( 15 ) found that the CRP and LDH levels can be used to reflect the therapeutic effect of MPP in children. Wang et al ( 16 ) showed that age, the total heat course, and the CRP, LDH and ESR levels in children with MPP mucus plug blockage were higher than those in the healthy subject group, suggesting that the increase in CRP, LDH and ESR can be used as an indicator of airway mucus embolism in children with MPP.…”

Clinical Significance of Pleural Effusion in Mycoplasma pneumoniae Pneumonia in Children

“…Although some studies reported predictive factors for a poor response to treatment in cases of MP pneumonia such as LDH, interleukin 18, and ferritin levels [ 15 , 23 , 24 ], to date, no study has focused on the clinical significance of pleural effusion in MP pneumonia. A previous study investigated the characteristics of pleural effusion in MP pneumonia in children and proved the presence of MP in the pleural effusion using PCR [ 9 ].…”

“…MP pneumonia was defined using the following three criteria: (1) acute respiratory symptoms, including fever, cough, and/or sputum; (2) proven MP infection based on the results of MP-specific IgM using blood samples and polymerase chain reaction (PCR) analysis of the sputum samples; and (3) abnormal chest radiograph and/or abnormal findings on physical examination, including abnormal breathing sounds. The presence of pleural effusion was diagnosed based on chest radiography findings [ 14 , 15 ]. The local Institutional Review Board (IRB) approved this study and waived the need for informed consent because of the retrospective study design (IRB No.…”

“…A “slow response” was defined as a slight improvement of respiratory symptoms and/or chest radiography findings within 1 week but not within 2–3 days of stepwise treatment of MP pneumonia. “No response or progression” was defined as no improvement or progression of respiratory symptoms and/or chest radiography findings even after 1 week of stepwise treatment for MP pneumonia [ 15 ]. Patients in the good and slow response groups were classified as the “response group” and those with no response to treatment or progression of MP pneumonia were classified as the “poor response group”.…”

“…All the patients had a confirmed MP infection based on the results obtained with a Mycoplasma pneumoniae real-time PCR kit (Biocore, Seoul, South Korea), which analyzed the enrolled patients’ sputum samples [ 18 ], and of the serologic tests for MP-specific IgM using the LIAISON MP IgM kit (DiaSorin, Dublin, Ireland) [ 15 ]. Macrolide resistance was evaluated by the identification of point mutations at sites 2063 or 2064 in domain V of 23S rRNA using the Mycoplasma pneumoniae real-time PCR kit (Biocore, Seoul, South Korea).…”