Surveillance of Macrolide-Resistant Mycoplasma pneumoniae in Beijing, China, from 2008 to 2012

Abstract

Macrolide resistance rates of Mycoplasma pneumoniae in the Beijing population were as high as 68.9%, 90.0%, 98.4%, 95.4%, and 97.0% in the years 2008 to 2012, respectively. Common macrolide-resistant mobile genetic elements were not detected with any isolate. These macrolide-resistant isolates came from multiple clones rather than the same clone. No massive aggregation of a particular clone was found in a specific period. Mycoplasma pneumoniae is one of the important pathogens causing human respiratory tract infection, especially in community-acquired pneumonia (1, 2). The major clinical treatment for M. pneumoniae infection is the use of macrolide antibiotics (ML). With the widespread use of the drug, ML-resistant isolates have been reported worldwide (3-5). The resistance mechanism has been identified as a point mutation in the 23S rRNA gene. Other mechanisms of macrolide resistance cannot be excluded and have not been identified. In recent years, ML-resistant M. pneumoniae has become very serious in Asia (6, 7) and has attracted the attention of scientists. Studies on ML-resistant M. pneumoniae in China have only recently been conducted, and the limited reports have been mainly ML resistance analyses of a small number of strains isolated during a few months and from specific populations, such as children or adults (8-11). These reports are lacking continuous full-population surveillance data of M. pneumoniae drug resistance. In view of the above-mentioned information, we have studied drug resistance of 309 M. pneumoniae isolates from a whole population of strains isolated from people with respiratory infections in Beijing, China, from 2008 to 2012, a study which will help us to understand the status of drug-resistant M. pneumoniae in Beijing in recent years.M. pneumoniae strains. A total of 309 M. pneumoniae strains were isolated from 1,183 respiratory infection specimens from Beijing Chao-Yang Hospital, Beijing Children's Hospital, and Beijing Centers for Diseases Control and Prevention. One hundred fifty-six isolates were from 388 pediatric specimens of patients Ͻ14 years of age, and the remaining 153 isolates were collected from 795 adolescent and adult specimens. All 309 isolates were purified, cultured, and identified with a real-time PCR method (12).Detection of macrolide resistance at the gene level. Genomic DNA of 309 M. pneumoniae isolates was extracted using the QIAamp DNA minikit (Qiagen). The extracts were distributed into aliquots and saved at Ϫ20°C. The domain V region of the 23S rRNA gene was amplified by PCR methods described previously (6). The amplification products were sequenced by the Beijing Genomics Institute (BGI). The results showed that there were existing point mutations in domain V of the 23S rRNA gene region of 280 strains in the 309 M. pneumoniae isolates. In 272 of the 280 isolates (97.1%), the mutation was identified as A2063G. Seven of the 280 isolates (2.5%) had the A2064G mutation, one of the 280 isolates (0.4%) had an A2063T mutation, and the remaining 29 isolates did not h...

Study of Two Separate Types of Macrolide-Resistant Mycoplasma pneumoniae Outbreaks

“…The strains isolated from these two outbreaks were all macrolide resistant; the results may be associated with that finding, though macrolide-resistant strains are common in Asia (23)(24)(25). The small range of the ages of the infected children represents a further limitation, as the students in the two classes were 7 years old and 9 years old, respectively.…”

Macrolide-Resistant Mycoplasma pneumoniae in Adults in Zhejiang, China

“…Between 2002 and 2008, a progressive increase in macrolide resistance from 5 to 39% among M. pneumoniae isolates was observed in Japan and even reached 87% in a recent year (3,26,27). Several Chinese studies reported a higher proportion of macrolide-resistant M. pneumoniae strains, ranging 63 to 92% (13,(28)(29)(30), obtained between 2003 and 2012 from patients with respiratory tract infections. Although it has been reported that the prevalence of macrolide-resistant M. pneumoniae is relatively lower in Europe and the United States, ranging from 3.6% in Germany (31) to 25.6% in Italy (2), the rate of resistance has also increased in these areas.…”

“…However, with the widespread use of the drug, increasing numbers of macrolide-resistant M. pneumoniae have been reported in the past decade, especially in Asia, Europe, and the United States (6,(10)(11)(12). In China, the infection rate of macrolide-resistant M. pneumoniae has reached up to 90% (13,14).…”

Regional Differences in Prevalence of Macrolide Resistance among Pediatric <i>Mycoplasma pneumoniae</i> Infections in Hokkaido, Japan

“…Since approximately the year 2000, macrolide-resistant (MR) M. pneumoniae has been appearing in Asia, Europe, Canada, and the USA (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). The rate of macrolide resistance among M. pneumoniae infections ranges from 3 to 26z in Europe (9,15), from 63 to 97z in China (16)(17)(18)(19), and from 25 to 93z in Japan (20)(21)(22). The total number of febrile days and the number of febrile days during macrolide administration are greater in patients infected with MR M. pneumoniae than in patients infected with macrolide-sensitive (MS) M. pneumoniae (23).…”