Prevalence and clinical manifestations of macrolide resistant Mycoplasma pneumoniae pneumonia in Korean children

Eun Lee, Hyun-Ju Cho, Soo-Jong Hong, Jina Lee, Heungsup Sung, Jinho Yu, Eun Lee, Hyun-Ju Cho, Soo-Jong Hong, Jina Lee, Heungsup Sung, Jinho Yu

Abstract

Purpose: Macrolide resistance rate of Mycoplasma pneumoniae has rapidly increased in children. Studies on the clinical features between macrolide susceptible-M. pneumoniae (MSMP) and macrolide resistant-M. pneumoniae (MRMP) are lacking. The aim of this study was to identify the macrolide resistance rate of M. pneumoniae in Korean children with M. pneumoniae penupmonia in 2015 and compare manifestations between MSMP and MRMP.

Methods: Among 122 children (0-18 years old) diagnosed with M. pneumoniae pneumonia, 95 children with the results of macrolide sensitivity test were included in this study. Clinical manifestations were acquired using retrospective medical records.

Results: The macrolide resistant rate of M. pneumoniae was 87.2% (82 of 94 patients) in children with M. pneumoniae pneumonia. One patient showed a mixed type of wild type and A2063G mutation in 23S rRNA of M. pneumoniae. There were no significant differences in clinical, laboratory, and radiologic findings between the MSMP and MRMP groups at the first visit to our hospital. The time interval between initiation of macrolide and defervescence was significantly longer in the MRMP group (4.9±3.3 vs. 2.8±3.1 days, P=0.039).

Conclusion: The macrolide resistant rate of M. pneumoniae is very high in children with M. pneumoniae pneumonia in Korea. The clinical manifestations of MRMP are similar to MSMP except for the defervescence period after administration of macrolide. Continuous monitoring of the occurrence and antimicrobial susceptibility of MRMP is required to control its spread and establish strategies for treating second-line antibiotic resistant M. pneumoniae infection.

Keywords: Child; Drug resistance; Macrolide; Mycoplasma pneumoniae.

Conflict of interest statement

Conflict of interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1. Rate of macrolide-resistant Mycoplasma pneumoniae…
Fig. 1. Rate of macrolide-resistant Mycoplasma pneumoniae in children according to age. P for trend=0.052.
Fig. 2. Monthly distribution of the occurrence…
Fig. 2. Monthly distribution of the occurrence of MSMP and MRMP pneumonia in Korean children in 2015. MSMP, macrolide susceptible-Mycoplasma pneumoniae; MRMP, macrolide resistant-M. pneumoniae.

References

    1. Eun BW, Kim NH, Choi EH, Lee HJ. Mycoplasma pneumoniae in Korean children: the epidemiology of pneumonia over an 18-year period. J Infect. 2008;56:326–331.
    1. Defilippi A, Silvestri M, Tacchella A, Giacchino R, Melioli G, Di Marco E, et al. Epidemiology and clinical features of Mycoplasma pneumoniae infection in children. Respir Med. 2008;102:1762–1768.
    1. Kwiatkowska B, Maślińska M. Macrolide therapy in chronic inflammatory diseases. Mediators Inflamm. 2012;2012:636157.
    1. Lucier TS, Heitzman K, Liu SK, Hu PC. Transition mutations in the 23S rRNA of erythromycin-resistant isolates of Mycoplasma pneumoniae. Antimicrob Agents Chemother. 1995;39:2770–2773.
    1. Hong KB, Choi EH, Lee HJ, Lee SY, Cho EY, Choi JH, et al. Macrolide resistance of Mycoplasma pneumoniae, South Korea, 2000–2011. Emerg Infect Dis. 2013;19:1281–1284.
    1. Dumke R, von Baum H, Lück PC, Jacobs E. Occurrence of macrolide-resistant Mycoplasma pneumoniae strains in Germany. Clin Microbiol Infect. 2010;16:613–616.
    1. Cao B, Zhao CJ, Yin YD, Zhao F, Song SF, Bai L, et al. High prevalence of macrolide resistance in Mycoplasma pneumoniae isolates from adult and adolescent patients with respiratory tract infection in China. Clin Infect Dis. 2010;51:189–194.
    1. Okada T, Morozumi M, Tajima T, Hasegawa M, Sakata H, Ohnari S, et al. Rapid effectiveness of minocycline or doxycycline against macrolide-resistant Mycoplasma pneumoniae infection in a 2011 outbreak among Japanese children. Clin Infect Dis. 2012;55:1642–1649.
    1. Principi N, Esposito S. Macrolide-resistant Mycoplasma pneumoniae: its role in respiratory infection. J Antimicrob Chemother. 2013;68:506–511.
    1. Miyashita N, Kawai Y, Akaike H, Ouchi K, Hayashi T, Kurihara T, et al. Macrolide-resistant Mycoplasma pneumoniae in adolescents with community-acquired pneumonia. BMC Infect Dis. 2012;12:126.
    1. Suzuki S, Yamazaki T, Narita M, Okazaki N, Suzuki I, Andoh T, et al. Clinical evaluation of macrolide-resistant Mycoplasma pneumoniae. Antimicrob Agents Chemother. 2006;50:709–712.
    1. Matsubara K, Morozumi M, Okada T, Matsushima T, Komiyama O, Shoji M, et al. A comparative clinical study of macrolide-sensitive and macrolide-resistant Mycoplasma pneumoniae infections in pediatric patients. J Infect Chemother. 2009;15:380–383.
    1. Liu Y, Ye X, Zhang H, Xu X, Li W, Zhu D, et al. Characterization of macrolide resistance in Mycoplasma pneumoniae isolated from children in Shanghai, China. Diagn Microbiol Infect Dis. 2010;67:355–358.
    1. McIntosh K. Community-acquired pneumonia in children. N Engl J Med. 2002;346:429–437.
    1. Yoo SJ, Kim HB, Choi SH, Lee SO, Kim SH, Hong SB, et al. Differences in the frequency of 23S rRNA gene mutations in Mycoplasma pneumoniae between children and adults with community-acquired pneumonia: clinical impact of mutations conferring macrolide resistance. Antimicrob Agents Chemother. 2012;56:6393–6396.
    1. Wolff BJ, Thacker WL, Schwartz SB, Winchell JM. Detection of macrolide resistance in Mycoplasma pneumoniae by real-time PCR and high-resolution melt analysis. Antimicrob Agents Chemother. 2008;52:3542–3549.
    1. Oh CE, Choi EH, Lee HJ. Detection of genetic mutations associated with macrolide resistance of Mycoplasma pneumoniae. Korean J Pediatr. 2010;53:178–183.
    1. Korea Centers for Disease Control and Prevention. Acute infectious agents laboratory surveillance reports [Internet] Cheongju: Korea Centers for Disease Control and Prevention; c2012. [cited 2014 Oct 2]. Available from: .
    1. Chironna M, Sallustio A, Esposito S, Perulli M, Chinellato I, Di Bari C, et al. Emergence of macrolide-resistant strains during an outbreak of Mycoplasma pneumoniae infections in children. J Antimicrob Chemother. 2011;66:734–737.
    1. Pereyre S, Charron A, Renaudin H, Bébéar C, Bébéar CM. First report of macrolide-resistant strains and description of a novel nucleotide sequence variation in the P1 adhesin gene in Mycoplasma pneumoniae clinical strains isolated in France over 12 years. J Clin Microbiol. 2007;45:3534–3539.
    1. Morozumi M, Takahashi T, Ubukata K. Macrolide-resistant Mycoplasma pneumoniae: characteristics of isolates and clinical aspects of community-acquired pneumonia. J Infect Chemother. 2010;16:78–86.
    1. Yang J, Hooper WC, Phillips DJ, Talkington DF. Cytokines in Mycoplasma pneumoniae infections. Cytokine Growth Factor Rev. 2004;15:157–168.
    1. Ye Y, Li S, Yajun L, Li Y, Ren T, Liu K. Mycoplasma pneumoniae 23S rRNA gene mutations and mechanisms of macrolide resistance. Lab Med. 2013;44:63–68.
    1. Cardinale F, Chironna M, Dumke R, Binetti A, Daleno C, Sallustio A, et al. Macrolide-resistant Mycoplasma pneumoniae in paediatric pneumonia. Eur Respir J. 2011;37:1522–1524.
    1. Sun H, Chen Z, Yan Y, Huang L, Wang M, Ji W. Epidemiology and clinical profiles of Mycoplasma pneumoniae infection in hospitalized infants younger than one year. Respir Med. 2015;109:751–757.

Source: PubMed

3
Abonneren