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Wang YS, Zhou YL, Bai GN, Li SX, Xu D, Chen LN, Chen X, Dong XY, Fu HM, Fu Z, Hao CL, Hong JG, Liu EM, Liu HM, Lu XX, Luo ZX, Tang LF, Tian M, Yin Y, Zhang XB, Zhang JH, Zhang HL, Zhao DY, Zhao SY, Zhu GH, Zou YX, Lu Q, Zhang YY, Chen ZM. Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. World J Pediatr 2024:10.1007/s12519-024-00831-0. [PMID: 39143259 DOI: 10.1007/s12519-024-00831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Mycoplasma pneumoniae (M. pneumoniae) is a significant contributor to community-acquired pneumonia among children. Since 1968, when a strain of M. pneumoniae resistant to macrolide antibiotics was initially reported in Japan, macrolide-resistant M. pneumoniae (MRMP) has been documented in many countries worldwide, with varying incidence rates. MRMP infections lead to a poor response to macrolide antibiotics, frequently resulting in prolonged fever, extended antibiotic treatment, increased hospitalization, intensive care unit admissions, and a significantly higher proportion of patients receiving glucocorticoids or second-line antibiotics. Since 2000, the global incidence of MRMP has gradually increased, especially in East Asia, which has posed a serious challenge to the treatment of M. pneumoniae infections in children and attracted widespread attention from pediatricians. However, there is still no global consensus on the diagnosis and treatment of MRMP in children. METHODS We organized 29 Chinese experts majoring in pediatric pulmonology and epidemiology to write the world's first consensus on the diagnosis and treatment of pediatric MRMP pneumonia, based on evidence collection. The evidence searches and reviews were conducted using electronic databases, including PubMed, Embase, Web of Science, CNKI, Medline, and the Cochrane Library. We used variations in terms for "macrolide-resistant", "Mycoplasma pneumoniae", "MP", "M. pneumoniae", "pneumonia", "MRMP", "lower respiratory tract infection", "Mycoplasma pneumoniae infection", "children", and "pediatric". RESULTS Epidemiology, pathogenesis, clinical manifestations, early identification, laboratory examination, principles of antibiotic use, application of glucocorticoids and intravenous immunoglobulin, and precautions for bronchoscopy are highlighted. Early and rapid identification of gene mutations associated with MRMP is now available by polymerase chain reaction and fluorescent probe techniques in respiratory specimens. Although the resistance rate to macrolide remains high, it is fortunate that M. pneumoniae still maintains good in vitro sensitivity to second-line antibiotics such as tetracyclines and quinolones, making them an effective treatment option for patients with initial treatment failure caused by macrolide antibiotics. CONCLUSIONS This consensus, based on international and national scientific evidence, provides scientific guidance for the diagnosis and treatment of MRMP in children. Further studies on tetracycline and quinolone drugs in children are urgently needed to evaluate their effects on the growth and development. Additionally, developing an antibiotic rotation treatment strategy is necessary to reduce the prevalence of MRMP strains.
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Affiliation(s)
- Ying-Shuo Wang
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Yun-Lian Zhou
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Guan-Nan Bai
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Shu-Xian Li
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Dan Xu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Li-Na Chen
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Xing Chen
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Xiao-Yan Dong
- Department of Pulmonology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Hong-Min Fu
- Department of Pulmonary and Critical Care Medicine, Kunming Children's Hospital, Kunming 650034, China
| | - Zhou Fu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Chuang-Li Hao
- Department of Pulmonology, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Jian-Guo Hong
- Department of Pediatrics, Shanghai General Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200080, China
| | - En-Mei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Han-Min Liu
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Xiao-Xia Lu
- Department of Respiratory Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Zheng-Xiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Lan-Fang Tang
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Man Tian
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Xiao-Bo Zhang
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Jian-Hua Zhang
- Department of Pediatric Pulmonology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201102, China
| | - Hai-Lin Zhang
- Department of Pediatric Respiratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - De-Yu Zhao
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Shun-Ying Zhao
- National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Guo-Hong Zhu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Ying-Xue Zou
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin 300074, China
| | - Quan Lu
- Department of Pulmonology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China.
| | - Yuan-Yuan Zhang
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
| | - Zhi-Min Chen
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
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Wang G, Wu P, Tang R, Zhang W. Global prevalence of resistance to macrolides in Mycoplasma pneumoniae: a systematic review and meta-analysis. J Antimicrob Chemother 2022; 77:2353-2363. [PMID: 35678262 DOI: 10.1093/jac/dkac170] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/03/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To determine the prevalence of resistance to macrolides in Mycoplasma pneumoniae worldwide. METHODS Prior to 12 December 2020, PubMed, Web of Science, Scopus and Embase databases were searched for epidemiological studies of M. pneumoniae resistance. Two reviewers independently extracted data from included studies. The extracted data include sampling population, total sampling number, the number of resistant strains and the molecular subtype of resistant strains. The estimate of resistance prevalence was calculated using the random-effects model. RESULTS A total of 17 873 strains were obtained from five continents and reported in 98 investigations between 2000 and 2020, with 8836 strains characterized as macrolide resistant. In summary, macrolide-resistant M. pneumoniae was most common in Asia (63% [95% CI 56, 69]). In Europe, North America, South America and Oceania, the prevalence was 3% [2, 7], 8.6% [6, 11], 0% and 3.3%, respectively. Over the last 20 years, the prevalence of macrolide-resistant M. pneumoniae has remained high in China (81% [73, 87]), with a significant increasing trend in South Korea (4% [1, 9] to 78% [49, 93], P < 0.0001). Furthermore, a point mutation at 2063 from A to G was mostly related to M. pneumoniae macrolide resistance. In terms of clinical outcomes, longer cough (mean difference [MD]: 2.93 [0.26, 5.60]) and febrile days (MD: 1.52 [1.12, 1.92]), and prolonged hospital stays (MD: 0.76 [0.05, 1.46]) might be induced by macrolide-resistant M. pneumoniae pneumonia. CONCLUSIONS The incidence of macrolide-resistant M. pneumoniae varies globally, with eastern Asia having a greater degree of resistance. However, attention is also required in other areas, and antibiotic alternatives should be considered for treatment in high-prevalence countries.
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Affiliation(s)
- Guotuan Wang
- Department of pharmacy, Karamay central hospital of Xinjiang, Karamay, Xinjiang, China
| | - Peng Wu
- Department of emergency, Karamay central hospital of Xinjiang, Karamay, Xinjiang, China
| | - Rui Tang
- Department of pharmacy, West China hospital, Sichuan university, Chengdu, Sichuan, China
| | - Weidong Zhang
- Department of pharmacy, Karamay central hospital of Xinjiang, Karamay, Xinjiang, China
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Lanata MM, Wang H, Everhart K, Moore-Clingenpeel M, Ramilo O, Leber A. Macrolide-Resistant Mycoplasma pneumoniae Infections in Children, Ohio, USA. Emerg Infect Dis 2021; 27:1588-1597. [PMID: 34013867 PMCID: PMC8153876 DOI: 10.3201/eid2706.203206] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Emergence of macrolide-resistant Mycoplasma pneumoniae (MRMp) challenges empiric macrolide therapy. Our goal was to determine MRMp rates and define characteristics of children infected with macrolide-sensitive M. pneumoniae (MSMp) versus MRMp in Ohio, USA. We cultured PCR-positive M. pneumoniae specimens and sequenced M. pneumoniae-positive cultures to detect macrolide resistance mutations. We reviewed medical records to compare characteristics of both groups. We identified 14 (2.8%) MRMp and 485 (97.2%) MSMp samples. Patients in these groups had similar demographics and clinical characteristics, but patients with MRMp had longer hospitalizations, were more likely to have received previous macrolides, and were more likely to have switched to alternative antimicrobial drugs. MRMp-infected patients also had ≈5-fold greater odds of pediatric intensive care unit admission. Rates of MRMp infections in children in central Ohio are low, but clinicians should remain aware of the risk for severe illness caused by these pathogens.
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Chen YC, Hsu WY, Chang TH. Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia. Emerg Infect Dis 2021; 26:1382-1391. [PMID: 32568052 PMCID: PMC7323531 DOI: 10.3201/eid2607.200017] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A high prevalence rate of macrolide-resistant Mycoplasma pneumoniae (MRMP) has been reported in Asia. We performed a systematic review and meta-analysis to investigate the effect of macrolide resistance on the manifestations and clinical judgment during M. pneumoniae infections. We found no difference in clinical severity between MRMP and macrolide-sensitive Mycoplasma pneumoniae (MSMP) infections. However, in the pooled data, patients infected with MRMP had a longer febrile period (1.71 days), length of hospital stay (1.61 day), antibiotic drug courses (2.93 days), and defervescence time after macrolide treatment (2.04 days) compared with patients infected with MSMP. The risk of fever lasting for >48 hours after macrolide treatment was also significantly increased (OR 21.24), and an increased proportion of patients was changed to second-line treatment (OR 4.42). Our findings indicate diagnostic and therapeutic challenges after the emergence of MRMP. More precise diagnostic tools and clearly defined treatment should be appraised in the future.
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Lim HJ, Kang ER, Park MY, Kim BK, Kim MJ, Jung S, Roh KH, Sung N, Yang JH, Lee MW, Lee SH, Yang YJ. Development of a multiplex real-time PCR assay for the simultaneous detection of four bacterial pathogens causing pneumonia. PLoS One 2021; 16:e0253402. [PMID: 34138947 PMCID: PMC8211157 DOI: 10.1371/journal.pone.0253402] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022] Open
Abstract
Classification of clinical symptoms and diagnostic microbiology are essential to effectively employ antimicrobial therapy for lower respiratory tract infections (LRTIs) in a timely manner. Empirical antibiotic treatment without microbial identification hinders the selective use of narrow-spectrum antibiotics and effective patient treatment. Thus, the development of rapid and accurate diagnostic procedures that can be readily adopted by the clinic is necessary to minimize non-essential or excessive use of antibiotics and accelerate patient recovery from LRTI-induced damage. We developed and validated a multiplex real-time polymerase chain reaction (mRT-PCR) assay with good analytical performance and high specificity to simultaneously detect four bacterial pathogens causing pneumonia: Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Moraxella catarrhalis. The analytical performance of mRT-PCR against target pathogens was evaluated by the limit of detection (LOD), specificity, and repeatability. Two hundred and ten clinical specimens from pneumonia patients were processed using an automatic nucleic acid extraction system for the “respiratory bacteria four” (RB4) mRT-PCR assay, and the results were directly compared to references from bacterial culture and/or Sanger sequencing. The RB4 mRT-PCR assay detected all target pathogens from sputum specimens with a coefficient of variation ranging from 0.29 to 1.71 and conservative LOD of DNA corresponding to 5 × 102 copies/reaction. The concordance of the assay with reference-positive specimens was 100%, and additional bacterial infections were detected from reference-negative specimens. Overall, the RB4 mRT-PCR assay showed a more rapid turnaround time and higher performance that those of reference assays. The RB4 mRT-PCR assay is a high-throughput and reliable tool that assists decision-making assessment and outperforms other standard methods. This tool supports patient management by considerably reducing the inappropriate use of antibiotics.
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Affiliation(s)
- Ho Jae Lim
- Department of Molecular Diagnostics, Seegene Medical Foundation, Seoul, Republic of Korea
- Department of Integrative Biological Sciences, Chosun University, Gwangju, Republic of Korea
| | - Eun-Rim Kang
- Department of Molecular Diagnostics, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Min Young Park
- Department of Molecular Diagnostics, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Bo Kyung Kim
- Department of Laboratory Medicine, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Min Jin Kim
- Department of Laboratory Medicine, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Sunkyung Jung
- Department of Molecular Diagnostics, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Kyoung Ho Roh
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi, Republic of Korea
| | - Nackmoon Sung
- Clinical Research Institute, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Jae-Hyun Yang
- Paul F. Glenn Center for Biology of Aging Research, Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA, United States of America
| | - Min-Woo Lee
- Soonchunhyang Institute of Medi-bio Science (SIMS) and Department of Integrated Biomedical Science, Soonchunhyang University, Cheonan-si, Republic of Korea
| | - Sun-Hwa Lee
- Department of Molecular Diagnostics, Seegene Medical Foundation, Seoul, Republic of Korea
- Department of Laboratory Medicine, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Yong-Jin Yang
- Department of Molecular Diagnostics, Seegene Medical Foundation, Seoul, Republic of Korea
- * E-mail:
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Xu C, Deng H, Zhang J, Zhu Y, Rong Q, Quan Y, Tang H, Zhao D. Mutations in domain V of Mycoplasma pneumoniae 23S rRNA and clinical characteristics of pediatric M. pneumoniae pneumonia in Nanjing, China. J Int Med Res 2021; 49:3000605211016376. [PMID: 34082582 PMCID: PMC8182226 DOI: 10.1177/03000605211016376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of mutations in domain V of Mycoplasma pneumoniae (MP) 23S ribosomal RNA (rRNA) and the clinical characteristics of pediatric MP pneumonia (MPP) in Nanjing, China. METHODS Domain V of 23S rRNA was sequenced in MP strains collected from children diagnosed with MPP in Nanjing. Clinical and laboratory data were obtained. RESULTS Among the 276 MP strains, 255 (92.39%) harbored mutations, primarily A2063G in domain V of MP 23S rRNA. When children were stratified according to the presence or absence of mutations, no significant differences were found in sex, age, the MP DNA load at enrollment, lymphocyte counts, pulmonary complications, immunomodulator levels, fever duration, the duration of fever after macrolide therapy, and hospital stay. The prevalence of refractory MPP in the two groups was similar. Children with refractory MPP exhibited higher MP DNA loads than those with non-refractory MPP. CONCLUSIONS Despite the high prevalence of the A2063G mutation in domain V of MP 23S rRNA, mutations were not associated with the clinical characteristics of MPP. The MP DNA load significantly differed between refractory and non-refractory MPP.
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Affiliation(s)
- Changdi Xu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Huan Deng
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jiamin Zhang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yifan Zhu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qiangquan Rong
- Department of Pediatrics, Nanjing Gaochun People's Hospital, Gaochun District, Nanjing, China
| | - Yao Quan
- Department of Pediatrics, Nanjing Gaochun People's Hospital, Gaochun District, Nanjing, China
| | - Heng Tang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Deyu Zhao
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
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Lee H, Choi YY, Sohn YJ, Kim YK, Han MS, Yun KW, Kim K, Park JY, Choi JH, Cho EY, Choi EH. Clinical Efficacy of Doxycycline for Treatment of Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Children. Antibiotics (Basel) 2021; 10:antibiotics10020192. [PMID: 33671151 PMCID: PMC7921960 DOI: 10.3390/antibiotics10020192] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 02/05/2023] Open
Abstract
In areas with high prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) pneumonia, treatment in children has become challenging. This study aimed to analyze the efficacy of macrolides and doxycycline with regard to the presence of macrolide resistance. We analyzed children with MP pneumonia during the two recent epidemics of 2014–2015 and 2019–2020 from four hospitals in Korea. Nasopharyngeal samples were obtained from children with pneumonia for MP cultures and polymerase chain reaction (PCR). Macrolide resistance was determined by the analysis of 23S rRNA gene transition. Time to defervescence and to chest X-ray improvement were analyzed. Of 145 cases, the median age was 5.0 years and MRMP accounted for 59 (40.7%). Among macrolide-susceptible MP (MSMP), 78 (90.7%) were treated with macrolides and 21 (35.6%) in the MRMP group with doxycycline. In MRMP pneumonia, shorter days to defervescence (2 vs. 5 days, p < 0.001) and to chest X-ray improvement (3 vs. 6 days, p < 0.001) in the doxycycline group than in the macrolide group was observed, whereas no differences were observed among children with MSMP pneumonia. Compared to macrolides, treatment with doxycycline resulted in better outcomes with a shorter time to defervescence and to chest X-ray improvement among children with MRMP pneumonia.
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Affiliation(s)
- Hyunju Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea; (H.L.); (K.W.Y.)
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Youn Young Choi
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul 03080, Korea; (Y.Y.C.); (Y.J.S.); (Y.K.K.)
| | - Young Joo Sohn
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul 03080, Korea; (Y.Y.C.); (Y.J.S.); (Y.K.K.)
| | - Ye Kyung Kim
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul 03080, Korea; (Y.Y.C.); (Y.J.S.); (Y.K.K.)
| | - Mi Seon Han
- Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Korea;
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea; (H.L.); (K.W.Y.)
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul 03080, Korea; (Y.Y.C.); (Y.J.S.); (Y.K.K.)
| | - Kyungmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Ji Young Park
- Department of Pediatrics, Chung-Ang University Hospital, Seoul 06973, Korea;
| | - Jae Hong Choi
- Department of Pediatrics, Jeju National University School of Medicine, Jeju 63241, Korea;
| | - Eun Young Cho
- Department of Pediatrics, Chungnam National University Hospital, Daejeon 35015, Korea;
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea; (H.L.); (K.W.Y.)
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul 03080, Korea; (Y.Y.C.); (Y.J.S.); (Y.K.K.)
- Correspondence:
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Abstract
Antimicrobial resistance is a global concern, and prudent use of antibiotics is essential to preserve the current armamentarium of effective drugs. Acute respiratory tract infection is the most common reason for antibiotic prescription in adults. In particular, community-acquired pneumonia poses a significant health challenge and economic burden globally, especially in the current landscape of a dense and aging population. By updating the knowledge on the common antimicrobial-resistant pathogens in community-acquired respiratory tract infections, their prevalence, and resistance may pave the way to enhancing appropriate antibiotic use in the ambulatory and health care setting.
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Lee E, Kim CH, Lee YJ, Kim HB, Kim BS, Kim HY, Kim Y, Kim S, Park C, Seo JH, Sol IS, Sung M, Song MS, Song DJ, Ahn YM, Oh HL, Yu J, Jung S, Lee KS, Lee JS, Jang GC, Jang YY, Chung EH, Chung HL, Choi SM, Choi YJ, Han MY, Shim JY, Kim JT, Kim CK, Yang HJ. Annual and seasonal patterns in etiologies of pediatric community-acquired pneumonia due to respiratory viruses and Mycoplasma pneumoniae requiring hospitalization in South Korea. BMC Infect Dis 2020; 20:132. [PMID: 32050912 PMCID: PMC7017508 DOI: 10.1186/s12879-020-4810-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background Community–acquired pneumonia (CAP) is one of the leading worldwide causes of childhood morbidity and mortality. Its disease burden varies by age and etiology and is time dependent. We aimed to investigate the annual and seasonal patterns in etiologies of pediatric CAP requiring hospitalization. Methods We conducted a retrospective study in 30,994 children (aged 0–18 years) with CAP between 2010 and 2015 at 23 nationwide hospitals in South Korea. Mycoplasma pneumoniae (MP) pneumonia was clinically classified as macrolide-sensitive MP, macrolide-less effective MP (MLEP), and macrolide-refractory MP (MRMP) based on fever duration after initiation of macrolide treatment, regardless of the results of in vitro macrolide sensitivity tests. Results MP and respiratory syncytial virus (RSV) were the two most commonly identified pathogens of CAP. With the two epidemics of MP pneumonia (2011 and 2015), the rates of clinical MLEP and MRMP pneumonia showed increasing trends of 36.4% of the total MP pneumonia. In children < 2 years of age, RSV (34.0%) was the most common cause of CAP, followed by MP (9.4%); however, MP was the most common cause of CAP in children aged 2–18 years of age (45.3%). Systemic corticosteroid was most commonly administered for MP pneumonia. The rate of hospitalization in intensive care units was the highest for RSV pneumonia, and ventilator care was most commonly needed in cases of adenovirus pneumonia. Conclusions The present study provides fundamental data to establish public health policies to decrease the disease burden due to CAP and improve pediatric health.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Chul-Hong Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Yong Ju Lee
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Hyo-Bin Kim
- Asthma and Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, South Korea
| | - Bong-Seong Kim
- Department of Pediatrics, Ulsan University Gangneung Asan Hospital, Gangneung, South Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, South Korea
| | - Yunsun Kim
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Sangyoung Kim
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Chorong Park
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Dankook University Hospital, Dankook University Medical School, Cheonan, South Korea
| | - In Suk Sol
- Department of Pediatrics, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
| | - Myongsoon Sung
- Department of Pediatrics, Soonchunhyang University Gumi Hospital, Seoul, South Korea
| | - Min Seob Song
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Pusan, South Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Young Min Ahn
- Department of Pediatrics, Eulji University, Eulji General Hospital, Seoul, South Korea
| | - Hea Lin Oh
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, South Korea
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, Ulsan University Medical School, Seoul, South Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, South Korea
| | - Kyung Suk Lee
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service, Ilsan Hospital, Ilsan, South Korea
| | - Yoon-Young Jang
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hai Lee Chung
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Sung-Min Choi
- Department of Pediatrics, Dongguk University Kyungju Hospital, Kyungju, South Korea
| | - Yun Jung Choi
- Department of Pediatrics, Seoul National University Children Hospital, Seoul, South Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Tack Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chang-Keun Kim
- Asthma and Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, South Korea.
| | - Hyeon-Jong Yang
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, South Korea. .,Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea.
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Early Corticosteroid Therapy for Mycoplasma pneumoniae Pneumonia Irrespective of Used Antibiotics in Children. J Clin Med 2019; 8:jcm8050726. [PMID: 31121867 PMCID: PMC6572103 DOI: 10.3390/jcm8050726] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 01/09/2023] Open
Abstract
Antibiotics’ effect on Mycoplasma pneumoniae (MP) infection still remains controversial. A prospective study of 257 children with MP pneumonia during a recent epidemic (2015–2016) was conducted. All MP pneumonia patients were treated with corticosteroids within 24–36 h after admission. Initially, oral prednisolone (1 mg/kg) or intravenous methylprednisolone (IVMP; 1–2 mg/kg) was administered for mild pneumonia patients, and IVMP (5–10 mg/kg/day) for severe pneumonia patients. If patients showed a persistent fever for 36–48 h or disease progression, additive IVMP (5 mg/kg or 10 mg/kg) was given. Thirty-three percent of patients received only a broad-spectrum antibiotic without a macrolide. The mean age and the male-to-female ratio was 5.6 ± 3.1 years and 1:1, respectively. Seventy-four percent of patients showed immediate defervescence within 24 h, and 96% of patients showed defervescence within 72 h with improvements in clinical symptoms. Three percent of patients (8/257) who received additive IVMP also showed clinical improvement within 48 h without adverse reactions. There were no clinical or laboratory differences between patients treated with a macrolide (n = 172) and without (n = 85). Early corticosteroid therapy might reduce disease morbidity and prevent disease progression in MP pneumonia patients without side effects, and antibiotics may have limited effects on MP infection.
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Choi JH, Seong GM, Ko Y, Kim YR, Kim C. Prevalence and Clinical Features of Community-Acquired Pneumonia Caused by Macrolide-Resistant Mycoplasma pneumoniae Isolated from Adults in Jeju Island. Microb Drug Resist 2019; 25:577-581. [DOI: 10.1089/mdr.2018.0295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jae Hong Choi
- Department of Pediatrics, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Gil Myeong Seong
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Yousang Ko
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young Ree Kim
- Department of Laboratory Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Changhwan Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
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12
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Chen Y, Tian WM, Chen Q, Zhao HY, Huang P, Lin ZQ, Chen L. [Clinical features and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:629-634. [PMID: 30111471 PMCID: PMC7389752 DOI: 10.7499/j.issn.1008-8830.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To study the clinical features of macrolide-resistant Mycoplasma pneumoniae pneumonia and its treatment regimens in children. METHODS The samples of throat swab or bronchoalveolar lavage fluid were collected from 136 children with Mycoplasma pneumoniae pneumonia. Quantitative real-time PCR was used to detect 2063/2064 A:G mutation in 23S rRNA, and according to such results, the children were divided into drug-resistance group with 81 children and sensitive group with 55 children. The two groups were compared in terms of age composition, respiratory symptoms, extrapulmonary complications, laboratory markers, imaging changes, treatment regimens, and length of hospital stay. RESULTS Compared with the sensitive group, the drug-resistance group had significantly longer duration of pyrexia and severe fever, a significantly higher percentage of children with reduced blood oxygen saturation, and significantly higher levels of alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) (P<0.05). The conventional azithromycin treatment had a good clinical effect in the sensitive group, while corticosteroid therapy was usually needed in the drug-resistance group. CONCLUSIONS Macrolide-resistant Mycoplasma pneumoniae infection cannot be identified based on a single clinical feature, but prolonged duration of pyrexia and severe fever, reduced blood oxygen saturation, and increased ALT and LDH can suggest the presence of this disease. Azithromycin combined with glucocorticoids may be a good treatment regimen for children with macrolide-resistant Mycoplasma pneumoniae pneumonia.
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Affiliation(s)
- Yu Chen
- Department of Pediatrics, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, China.
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13
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Chen Y, Tian WM, Chen Q, Zhao HY, Huang P, Lin ZQ, Chen L. [Clinical features and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:629-634. [PMID: 30111471 PMCID: PMC7389752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/10/2018] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To study the clinical features of macrolide-resistant Mycoplasma pneumoniae pneumonia and its treatment regimens in children. METHODS The samples of throat swab or bronchoalveolar lavage fluid were collected from 136 children with Mycoplasma pneumoniae pneumonia. Quantitative real-time PCR was used to detect 2063/2064 A:G mutation in 23S rRNA, and according to such results, the children were divided into drug-resistance group with 81 children and sensitive group with 55 children. The two groups were compared in terms of age composition, respiratory symptoms, extrapulmonary complications, laboratory markers, imaging changes, treatment regimens, and length of hospital stay. RESULTS Compared with the sensitive group, the drug-resistance group had significantly longer duration of pyrexia and severe fever, a significantly higher percentage of children with reduced blood oxygen saturation, and significantly higher levels of alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) (P<0.05). The conventional azithromycin treatment had a good clinical effect in the sensitive group, while corticosteroid therapy was usually needed in the drug-resistance group. CONCLUSIONS Macrolide-resistant Mycoplasma pneumoniae infection cannot be identified based on a single clinical feature, but prolonged duration of pyrexia and severe fever, reduced blood oxygen saturation, and increased ALT and LDH can suggest the presence of this disease. Azithromycin combined with glucocorticoids may be a good treatment regimen for children with macrolide-resistant Mycoplasma pneumoniae pneumonia.
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Affiliation(s)
- Yu Chen
- Department of Pediatrics, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, China.
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