Severe macrolide-resistant Mycoplasma pneumoniae pneumonia associated with macrolide failure

Cheong, Kai-Ning; Chiu, Susan S.; Chan, Betsy W. K.; To, Kelvin Kai-Wang; Chan, Eunice Lai-Yin; Ho, Pak-Leung

doi:10.1016/j.jmii.2014.11.003

Cited by 33 publications

(37 citation statements)

References 10 publications

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“…Although previous data from patients with MRMP pneumonia suggest that the presence of resistance did not increase the overall severity of disease, recent reports have demonstrated that disease progression during therapy, with increased complications, occurred in patients with MRMP pneumonia 2021. Surveillance data from Japan have also shown that cases requiring hospitalization have gradually increased as MRMP pneumonia in children increased 8.…”

Section: Discussionmentioning

confidence: 91%

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

Kim

Yoo³

et al. 2017

Allergy Asthma Immunol Res

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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.

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Section: Discussionmentioning

confidence: 91%

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

Kim

Yoo³

et al. 2017

Allergy Asthma Immunol Res

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“…This retrospective study was conducted in a health care region in Hong Kong comprising one university-affiliated hospital with 1,600 beds, three extended-care hospitals with a total of 1,600 beds, and one pediatric hospital with 160 beds. A diagnostic PCR assay for M. pneumoniae was provided as a routine service for inpatients by a clinical microbiology laboratory (7,16). Testing was initiated by clinicians, mainly in patients with features suspected to be due to M. pneumoniae pneumonia (2,17).…”

Section: Methodsmentioning

confidence: 99%

“…In nine patients, no information on the syndromic diagnosis was available. Clinical features and macrolide resistance genotyping results for 101 of the patients were reported previously (7,16). Nucleic acid extracts from the 257 patients with positive M. pneumoniae results were retrospectively retrieved for further testing.…”

Section: Methodsmentioning

confidence: 99%

“…However, macrolideresistant M. pneumoniae (MRMP) has become increasingly prevalent worldwide, and high rates of infection (Ͼ80%) have been found in certain parts of the world (3-6). MRMP infections have been associated with persistence of symptoms, slower reduction in bacterial load, longer hospital stays, requirement of alternative therapy, and higher frequency of complications (1,7,8). Strain typing is important for understanding changes in disease epidemiology and for investigations of outbreaks.…”

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confidence: 99%

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Emergence of Macrolide-Resistant Mycoplasma pneumoniae in Hong Kong Is Linked to Increasing Macrolide Resistance in Multilocus Variable-Number Tandem-Repeat Analysis Type 4-5-7-2

Law

Chan

et al. 2015

J Clin Microbiol

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Macrolide-resistant Mycoplasma pneumoniae (MRMP) is rapidly emerging in Asia, but information on the temporal relationship between the increase in macrolide resistance and changes in strain types is scarce. Between 2011 and 2014, M. pneumoniae infection was diagnosed by PCR as part of routine care in a health care region in Hong Kong. Testing was initiated by clinicians, mainly in patients with suspected M. pneumoniae pneumonia. Specimens positive for M. pneumoniae were retrospectively investigated by macrolide resistance genotyping and a four-locus (Mpn13 to -16) multilocus variable-number tandem-repeat analysis (MLVA) scheme. The overall percentage of M. pneumoniae-positive specimens was 17.9%, with annual rates ranging from 9.8% to 27.2%. The prevalence of MRMP had rapidly increased from 13.6% in 2011 to 30.7% in 2012, 36.6% in 2013, and 47.1% in 2014 (P ‫؍‬ 0.038). Two major MLVA types, 4-5-7-2 and 3-5-6-2, accounted for 75% to 85% of the infections each year. MLVA types 4-5-7-2 and 3-5-6-2 predominated among macrolide-resistant and macrolide-sensitive groups, respectively. The increase in MRMP was mainly caused by increasing macrolide resistance in the prevalent MLVA type 4-5-7-2, changing from 25.0% in 2011 to 59.1% in 2012, to 89.7% in 2013, and to 100% in 2014 (P < 0.001). In conclusion, increasing MRMP in Hong Kong was linked to a single MLVA type, which was both prevalent and increasingly resistant to macrolides. Mycoplasma pneumoniae is a common cause of communityacquired pneumonia and other respiratory tract infections (1). Community epidemics occur at intervals of 3 to 7 years. Infections develop in persons of all ages, but it is primarily a disease of children and teenagers (2). When treatment is indicated, a macrolide is usually the drug of choice (1, 2). However, macrolideresistant M. pneumoniae (MRMP) has become increasingly prevalent worldwide, and high rates of infection (Ͼ80%) have been found in certain parts of the world (3-6). MRMP infections have been associated with persistence of symptoms, slower reduction in bacterial load, longer hospital stays, requirement of alternative therapy, and higher frequency of complications (1,7,8). Strain typing is important for understanding changes in disease epidemiology and for investigations of outbreaks. In 2009, a multilocus variable-number tandem-repeat analysis (MLVA) scheme based upon five loci (Mpn1 and Mpn13 to -16) was developed for the molecular typing of M. pneumoniae (9). It was initially used for an investigation of isolates but was later modified for directly typing M. pneumoniae in respiratory specimens (10-12). An amended 4-locus MLVA scheme was later proposed after studies raised concerns on the instability of the Mpn1 locus (13,14). In clinical laboratories, culture and characterization of M. pneumoniae are seldom performed. Therefore, M. pneumoniae typing was usually carried out on isolates collected from sporadic cases and outbreaks (9,13,15), limiting the inferences that can be made about trends in M. pneumoniae infections. In addit...

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“…However, macrolide resistance of M. pneumoniae, which is acquired by mutations of the ribosomal target of macrolides,11 has been spreading rapidly and widely since 2000,12 resulting in enhanced disease severity with increased complications 13, 14…”

Section: Introductionmentioning

confidence: 99%

Clinical features and seasonal variations in the prevalence of macrolide‐resistant Mycoplasma pneumoniae

Akashi

Hayashi

Suzuki

et al. 2018

J of Gen and Family Med

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Background Mycoplasma pneumoniae is a common pathogen causing pneumonia; macrolide‐resistant strains are rapidly spreading across Japan. However, the clinical features of macrolide‐resistant M. pneumoniae pneumonia have not been well established. Here, we evaluated the clinical characteristics and seasonal variations in the prevalence of M. pneumoniae with macrolide‐resistant mutations (MRM).MethodsThe monthly prevalence of MRM in M. pneumoniae strains isolated from May 2016 to April 2017 was retrospectively analyzed, and the clinical characteristics of pneumonia cases with MRM were compared to those of cases without MRM. The M. pneumoniae isolates and point mutations at site 2063 or 2064 in domain V of 23S rRNA were evaluated by the GENECUBE system and GENECUBE Mycoplasma detection kit.Results Mycoplasma pneumoniae infection was identified in 383 cases, including 221 cases of MRM (57.7%). The MRM prevalence was 86.3% (44/51) between May and July 2016, demonstrating an apparent decrease in September 2016, subsequently reaching 43.0% (34/79) in November 2016. Mycoplasma pneumoniae pneumonia was diagnosed in 275 cases, including 222 pediatric and 53 adult cases. Macrolide use preceding evaluation was found to be the only feature of MRM pneumonia cases both in children (odds ratio [OR] 3.86, 95% confidence interval [CI]:1.72–8.66) and in adults (OR 7.43, 95% CI: 1.67–33.1).ConclusionsThe determination rate of MRM varied widely throughout the year, and our study demonstrated the challenges in predicting M. pneumoniae with MRM based on clinical features at diagnosis. Therefore, continuous monitoring of the prevalence of MRM is warranted, which may help in selecting an effective treatment.

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Severe macrolide-resistant Mycoplasma pneumoniae pneumonia associated with macrolide failure

Cited by 33 publications

References 10 publications

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

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

Emergence of Macrolide-Resistant Mycoplasma pneumoniae in Hong Kong Is Linked to Increasing Macrolide Resistance in Multilocus Variable-Number Tandem-Repeat Analysis Type 4-5-7-2

Clinical features and seasonal variations in the prevalence of macrolide‐resistant Mycoplasma pneumoniae

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