1
|
Sun Q, Hao J, Zhou Q, Zeng Y. Clinical Characteristics and Treatment Outcomes of Pediatric Drug-Resistant Mycoplasma pneumoniae Pneumonia in the Post-COVID-19 Era. Infect Drug Resist 2025; 18:957-963. [PMID: 39990785 PMCID: PMC11846524 DOI: 10.2147/idr.s502937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 01/22/2025] [Indexed: 02/25/2025] Open
Abstract
Background Mycoplasma pneumoniae pneumonia (MPP) is a prevalent disease among children. Typically, macrolides are the first-line treatment for MPP in China. However, the number of cases resistant to macrolides has been rising, especially after the outbreak of the COVID-19 pandemic, which has further complicated the clinical management of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) in children. Objective This study examined the clinical characteristics of MUMPP and the effects of various treatments on children with MUMPP during March 2023 to February 2024 in southern China. Methods We conducted a retrospective case-control study at a university-affiliated hospital in southern China. Patients were categorized based on their response to macrolide treatment into two groups: MUMPP and control group. The study included 549 pediatric patients. Of these, 297 were in the MUMPP group and 252 were in the control group. This categorization allowed us to compare clinical characteristics and laboratory indicators between the groups. The MUMPP group received one of the three treatments: combined antibiotics, additional steroids, or a switch to doxycycline. Subsequently, we analyzed differences in clinical outcomes, which included hospital stay, hospital cost, and recovery time. Results No significant differences were found in gender or pre-admission disease duration between the MUMPP and control group (P>0.05). However, subjects in MUMPP group was older, had longer fever durations, extended hospital stays, higher medical costs, and elevated levels of C-reactive protein, lactate dehydrogenase, IL-6, and γ-IFN. All of which showed statistically significant differences (P<0.05). Within the MUMPP group, patients switched to doxycycline had the shortest hospital stay and recovery time, significantly differing from those in other treatment groups (P<0.05). Conclusion Children in the MUMPP group exhibited higher inflammatory indicators than the control group. The early adaptation of treatment strategies, particularly the switch to doxycycline, is associated with improved clinical outcomes.
Collapse
Affiliation(s)
- Qin Sun
- Pediatrics Department, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, People’s Republic of China
| | - Jindou Hao
- Pediatrics Department, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, People’s Republic of China
| | - Qixin Zhou
- Pediatrics Department, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, People’s Republic of China
| | - Yongmei Zeng
- Pediatrics Department, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, People’s Republic of China
| |
Collapse
|
2
|
Ma J, Tian T, Zeng N, Gu Y, Ren X, Jin Z. The value of common blood parameters for the differential diagnosis of respiratory tract infections in children. AMB Express 2025; 15:25. [PMID: 39918743 PMCID: PMC11806179 DOI: 10.1186/s13568-025-01829-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 01/26/2025] [Indexed: 02/09/2025] Open
Abstract
Mycoplasma pneumoniae and influenza A virus are common pathogens that cause respiratory tract infection in children. Both pathogens present with similar clinical symptoms, and their epidemic periods often overlap. Consequently, it is challenging for clinicians to make a rapid preliminary diagnosis. However, common blood tests is simple and efficient, Therefore, the purpose of this study is to preliminarily distinguish Mycoplasma pneumoniae and influenza A virus infection in children by analyzing the results of common blood tests, thereby guiding clinical diagnosis and treatment.The results showed that, compared with children in the influenza A virus-positive group, children in the Mycoplasma pneumoniae-positive group had higher white blood cell (WBC), red blood cell (RBC), haemoglobin (HGB), platelet (PLT) counts, lymphocyte (LYM) and eosinophil (EOS) counts and ratios, as well as higher concentrations of C-reactive protein (CRP) and serum amyloid A (SAA), while neutrophil (NEU) and monocyte (MONO) counts and ratios, Neutrophil to Lymphocyte ratio( NLR) were lower, in addition, LYM, EOS counts and ratios, and NLR were all more effective in differentiating between the two pathogen infections, A combined analysis of these indicators further improved the differentiation efficacy. Therefore, LYM and EOS counts and ratios, along with NLR, can serve as effective blood parameters for differentiating Mycoplasma pneumoniae infections from influenza A virus infections in children.
Collapse
Affiliation(s)
- Jun'e Ma
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Ting Tian
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Nianyi Zeng
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Yue Gu
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Xuewei Ren
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Zhengjiang Jin
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
| |
Collapse
|
3
|
Fu C, Mo L, Feng Y, Zhu N, Huang H, Huang Z, Lu C, Wei Y, Zhao J, Lu X, Chen R, Yao R, Wu L, Liu G, Li M, Ruan J, Chen J, Jiang S, Huang Y, Li Q, Tan J. Detection of Mycoplasma pneumoniae in hospitalized pediatric patients presenting with acute lower respiratory tract infections utilizing targeted next-generation sequencing. Infection 2025:10.1007/s15010-024-02467-8. [PMID: 39888587 DOI: 10.1007/s15010-024-02467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 12/27/2024] [Indexed: 02/01/2025]
Abstract
BACKGROUND Mycoplasma pneumoniae is a prevalent pathogen in pediatric community-acquired pneumonia. Currently, limited literature exists on the clinical utilization of pathogen-targeted sequencing technologies. METHODS Targeted next-generation sequencing (tNGS) technology was employed to analyze bronchoalveolar lavage fluid (BALF) from 1,070 hospitalized pediatric patients with acute lower respiratory tract infections. Subsequently, the clinical data of children diagnosed with Mycoplasma pneumoniae pneumonia were systematically evaluated. RESULTS tNGS identified pathogenic infections in 1,064 (99.4%) of these patients, with M. pneumoniae infections representing 56.9% of the cases. Of these with M. pneumoniae cases, 169 patients (27.75%, 169/609) had infections solely due to with M. pneumoniae, while 440 patients (72.25%, 440/609) presented with co-infections involving M. pneumoniae and additional microorganisms. Among the co-infections, Rhinovirus was the most frequent co-infecting pathogen (120/609), followed by Streptococcus pneumoniae (91/609), human respiratory syncytial virus (78/609) and human parainfluenza virus (74/609). Among the 609 children identified M. pneumoniae infection, 274 were found to harbor macrolide-resistant M. pneumoniae (MRMP), yielding a resistance rate of 45.0% (274/609). In children with M. pneumoniae infection, pleural effusion and respiratory failure emerged as the most prevalent respiratory complications, while hepatic impairment and myocardial impairment were the predominant complications of other systems. The median duration of hospitalization for the children diagnosed with M. pneumoniae infection was 7 days. Out of 609 children with M. pneumoniae infection, 10 cases required intensive care unit (ICU) admission, accounting for 1.64% of the total. CONCLUSION tNGS technology exhibits substantial clinical utility in identifying pathogens associated with respiratory tract infections. This study delineates the clinical manifestations and co-infection patterns of M. pneumoniae in Guangxi, China.
Collapse
Affiliation(s)
- Chunyun Fu
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China.
| | - Lishai Mo
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Yanhua Feng
- Department of Pediatric Respiratory Medicine, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Ning Zhu
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Huiping Huang
- Department of Pediatric Respiratory Medicine, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Ziyin Huang
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Cuihong Lu
- Department of Pediatric Respiratory Medicine, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Yubing Wei
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Jiangyang Zhao
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Xiangjun Lu
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Ruting Chen
- Department of Pediatric Respiratory Medicine, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - RenYe Yao
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Li Wu
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Guangbing Liu
- Department of Pediatric Respiratory Medicine, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Mengjun Li
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Jialing Ruan
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Jielin Chen
- Department of Pediatric Respiratory Medicine, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Silin Jiang
- Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China
| | - Ya Huang
- Department of Pediatric Respiratory Medicine, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China.
| | - Qifei Li
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine and Holtz Children's Hospital, Jackson Health System, Miami, FL, 33136, USA.
| | - Jie Tan
- Department of Pediatric Respiratory Medicine, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China.
| |
Collapse
|
4
|
Wu D, Xie FJ, Wang YJ, Jiang XH, Zhang GL, Zhang H, Zhu YC, Zhang Y, Tang YJ, Lin YL, Xu JX, Zhang JN, Liu BW, Kang K, Gao Y. Compassionate Use of Omadacycline in a Down Syndrome Pre-Schooler With Critically Ill Atypical Pneumonia Caused by Macrolide-Resistant Mycoplasma Pneumoniae. Infect Drug Resist 2025; 18:391-400. [PMID: 39867285 PMCID: PMC11761846 DOI: 10.2147/idr.s500982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Accepted: 01/16/2025] [Indexed: 01/28/2025] Open
Abstract
Background Rapid and accurate identification of causative organisms and prompt initiation of pathogen-targeted antibiotics are crucial for managing atypical pneumonia. The widespread application of targeted next-generation sequencing (t-NGS) in clinical practice demonstrates significant targeted advantages in rapid and accurate aetiological identification and antimicrobial resistance genes detection, particularly for difficult-to-culture, rare, or unexpected pathogens. An alarming surge of acquired macrolide resistance (MR) in Mycoplasma pneumoniae (MP) presents a substantial challenge for the clinical selection of pathogen-targeted antibiotics worldwide, especially for fluoroquinolone-restricted pediatric patients with limited options available. Case Presentation In this case report, we present for the first time the compassionate use of omadacycline (OMC) in a Down syndrome pre-schooler with critically ill atypical pneumonia caused by macrolide-resistant MP. The treatment achieved a favourable therapeutic effect without any related adverse events (AEs) during hospitalization and follow-up. Conclusion In clinical practice, rapid and accurate identification of causative organisms should be a priority for prompt initiation of pathogen-targeted antibiotics, in which tNGS possesses enormous potential, particularly for difficult-to-culture MP. At present, OMC is not recommended in the package insert for clinical application in pediatric patients under 8 years of age due to potential age-specific AEs on tooth colour and development as well as bone growth. The superior efficacy and safety of OMC in the management of critically ill atypical pneumonia caused by macrolide-resistant MP were comprehensively documented in this Down syndrome pre-schooler, which merits future well-designed studies to validate our findings, enhance understanding of the features of OMC, and further expand its clinical application in preschool-aged patients.
Collapse
Affiliation(s)
- Di Wu
- Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Feng-Jie Xie
- Department of Critical Care Medicine, The Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang Province, People’s Republic of China
| | - Ya-Jun Wang
- Department of Pediatrics, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Xiao-Hui Jiang
- Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Guo-Li Zhang
- Department of Pediatrics, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Hong Zhang
- Department of Critical Care Medicine, The Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang Province, People’s Republic of China
| | - Yu-Cheng Zhu
- Department of Critical Care Medicine, The Hongxinglong Hospital of Beidahuang Group, Shuangyashan, Heilongjiang Province, People’s Republic of China
| | - Yan Zhang
- Department of Critical Care Medicine, The Hongxinglong Hospital of Beidahuang Group, Shuangyashan, Heilongjiang Province, People’s Republic of China
| | - Yu-Jia Tang
- Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Yi-Lu Lin
- Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Jia-Xi Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Jia-Ning Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Bo-Wen Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Kai Kang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Yang Gao
- Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| |
Collapse
|
5
|
Wang L, Li Q, Hu J, Luo R, Duan Y, Ai T. Characterization of diffuse lung function in children with Mycoplasma pneumoniae pneumonia. Front Pediatr 2025; 12:1443877. [PMID: 39834489 PMCID: PMC11743651 DOI: 10.3389/fped.2024.1443877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 12/09/2024] [Indexed: 01/22/2025] Open
Abstract
Background Mycoplasma pneumoniae infection accounts for a high proportion of community-acquired pneumonia and the incidence rate of severe M. pneumoniae pneumonia (MPP) has increased year by year. This study investigated the changes in lung diffusion function after M. pneumoniae infection, compared the lung diffusion and ventilation function of children with mild (MMPP) or severe M. pneumoniae pneumonia (SMPP) infections, and explored their clinical significance. Objective To study the changes in pulmonary ventilation and pulmonary diffusion function in children with MPP, and explore their clinical significance. Methods Data from 97 children with M. pneumoniae pneumonia hospitalized in Chengdu Women and Children's Central Hospital from June 2023 to December 2023 were collected and the participants were divided into an MMPP group (n = 44) and an SMPP group (n = 53). The changes in pulmonary ventilation function and diffusion function were compared between the two groups. Results The Z-scores of forced vital capacity and forced expiratory volume in the first second in the SMPP and MMPP groups were -1.684 ± 0.902 and -1.986 ± 0.818, and 0.164 ± 1.795 and -0.6104 ± 1.276, respectively. In the SMPP group, the two aforementioned indicators were lower than the normal value and significantly lower than those in the MMPP group (P < 0.001). The carbon monoxide diffusion capacity in the SMPP group (-5.931 ± 0.827) was significantly lower than that in the MMPP group (-5.0775 ± 1.1134) (P < 0.001). The forced expiratory flow at 75% vital capacity and the maximum mid expiratory flow in the SMPP group were -2.006 ± 1.2582 and -1.878 ± 1.008, respectively, which were lower than the normal value. Conclusion SMPP results in more severe ventilation dysfunction and diffuse dysfunction than MMPP.
Collapse
Affiliation(s)
| | | | | | | | | | - Tao Ai
- Pediatric Respiratory Medicine Department, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
6
|
Li D, Zheng H, Wang X, Li F, Wang H, Chen H, Shen C, Zhao S. Investigation of T lymphocyte subsets in children with Mycoplasma pneumoniae pneumonia. Immunol Res 2024; 73:24. [PMID: 39714538 DOI: 10.1007/s12026-024-09576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 10/19/2024] [Indexed: 12/24/2024]
Abstract
This study aims to characterize the majority of immune cell subsets in peripheral blood mononuclear cells in children with Mycoplasma pneumoniae pneumonia (MPP) by a 21-color flow cytometry panel. Patients who met the predetermined eligibility criteria for pneumonia diagnosis were recruited for the research study. Multi-color flow cytometry was conducted on the peripheral blood mononuclear cells of each patient group, which were then subjected to dimensionality reduction and cluster analysis. In our study, the proportion of activated CD4 + T cell and naïve CD8 + T in children with MPP was higher than that of children with non-MPP, and the proportion of CD8 + T cell and central memory CD8 + T cell in MPP children was lower. Central memory CD4 + T cell and activated CD4 + T cell in the severe MPP were higher than those in the mild MPP. The highest proportions of CD8 + T cell, CD8 + Tn cell, activated CD8 + T cell, and total activated T cell were observed in the pulmonary consolidation-mucous group when compared to the pulmonary consolidation-necrosis and bronchiolitis groups. In the pulmonary consolidation-necrosis group, the proportions of central memory CD4 + T cell and T helper 17 cell were higher than those in pulmonary consolidation-mucous and bronchiolitis groups. In the bronchiolitis group, the percentages of CD4 + T cell, naïve CD4 + T cell, and T helper 2 cell were higher than those in pulmonary consolidation-mucous and the pulmonary consolidation-necrosis groups. The T lymphocyte subsets were different among various groups, offering new insights into the immune system of pediatric patients with Mycoplasma pneumoniae pneumonia.
Collapse
Affiliation(s)
- Deze Li
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Huiwen Zheng
- Laboratory of Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Xiaotong Wang
- Laboratory of Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Feina Li
- Laboratory of Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Heng Wang
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Hao Chen
- Laboratory of Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Chen Shen
- Laboratory of Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Capital Medical University, Beijing, 100045, China.
| | - Shunying Zhao
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China.
| |
Collapse
|
7
|
Lu Y, Li WJ, Wang XX, Huang AQ, Cheng H. Risk factors and prescription patterns analysis for macrolide-resistant Mycoplasma pneumoniae pneumonia in children. iScience 2024; 27:111503. [PMID: 39759004 PMCID: PMC11699248 DOI: 10.1016/j.isci.2024.111503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/05/2024] [Accepted: 11/27/2024] [Indexed: 01/07/2025] Open
Abstract
First-line macrolide therapy is encountering challenges due to the escalating incidence of macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP). This study aimed to illustrate prescription patterns among children diagnosed with either macrolide-sensitive Mycoplasma pneumoniae pneumonia (MSMPP) or MRMPP and to further analyze the risk factors associated with MRMPP. This research encompassed 825 children who were diagnosed with Mycoplasma pneumoniae pneumonia (MPP) at a tertiary hospital located in central China in 2023. Notably, the MRMPP group had a longer fever duration compared to the MSMPP group. A combination of doxycycline and piperacillin-tazobactam was the most frequently used treatment for hospitalized MRMPP children, whereas azithromycin was the primary choice for the MSMPP group. More children in the MRMPP group required discharge medications, primarily doxycycline, whereas the MSMPP group primarily received azithromycin. Furthermore, a history of allergy emerged as an increased risk factor for MRMPP, alongside age, fever, pulmonary imaging changes, and co-detections of bacteria or fungi.
Collapse
Affiliation(s)
- Yun Lu
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen-jing Li
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuan-xuan Wang
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - An-qi Huang
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hong Cheng
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
8
|
Wang Z, Peng Y, Yang S, Chen Z, Wang H, Li H, Li X. Risk factors for complications of Mycoplasma pneumoniae pneumonia in hospitalized children in China: a systematic review and meta-analysis. BMC Pediatr 2024; 24:810. [PMID: 39696115 DOI: 10.1186/s12887-024-05279-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 11/25/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Mycoplasma pneumoniae pneumonia (MPP) is a common respiratory disease in children. Some patients may develop long-term respiratory issues such as chronic cough and wheezing due to complications. These complications increase the health burden for children with MPP, highlighting the need to understand their risk factors in order to improve disease prognosis. This study aims to assess the risk factors for complications in hospitalized children with MPP in China. METHODS A comprehensive review of Chinese and English databases was conducted up to April 2024 to retrieve studies focusing on complications in hospitalized children with MPP. Pooled effect sizes were calculated using random-effects or fixed-effects models. Statistical analyses were performed using R software and RevMan 5.3. RESULTS This meta-analysis encompassed a total of 17 studies. We analyzed multiple risk factors associated with complications, including prolonged fever (OR: 3.79, aOR: 1.64), pleural effusion (OR: 3.71, aOR: 6.70), extensive lung infiltration (OR: 5.52, aOR: 3.57), ≥ 2/3 consolidation in a single lung lobe (OR: 4.29, aOR: 4.52), right upper lung lesion (OR: 4.84, aOR: 3.57), extrapulmonary manifestations (OR: 3.20, aOR: 1.89), hypoxemia (OR: 7.58, aOR: 12.43), delayed administration of glucocorticoids (OR: 7.93, aOR: 6.67), and delayed administration of macrolides (OR: 2.75, aOR: 3.84). CONCLUSION Hospitalized children with SMPP and RMPP may have a higher risk of complications, and it is important to identify risk factors early and provide appropriate treatment to minimize complications. The current level of evidence is relatively low and may not accurately reflect the actual clinical situation in China. Further high-quality studies are needed to validate and clarify these findings. TRIAL REGISTRATION Our protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42024534397).
Collapse
Affiliation(s)
- Ziyu Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China
| | - Yingying Peng
- Binhai New Area Hospital of TCM, Tianjin, 300451, China
- Fourth Teaching Hospital of Tianjin University of TCM, Tianjin, 300451, China
| | - Shuo Yang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China
| | - Zhe Chen
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin, 301617, China
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- National Key Laboratory of Chinese Medicine Modernization, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Huizhe Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China
| | - Huanmin Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China
| | - Xinmin Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China.
| |
Collapse
|
9
|
Gao L, Sun Y. Laboratory diagnosis and treatment of Mycoplasma pneumoniae infection in children: a review. Ann Med 2024; 56:2386636. [PMID: 39097794 PMCID: PMC11299444 DOI: 10.1080/07853890.2024.2386636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 08/05/2024] Open
Abstract
Mycoplasma pneumoniae (MP) is the cause of Mycoplasma pneumoniae pneumonia (MPP) in children and adolescents, with the clinical manifestations highlighted by intermittent irritating cough, accompanied by headache, fever and muscle pain. This paper aimed to study the research status and focal points in MP infection, especially the common laboratory diagnostic methods and clinical treatment of Mycoplasma pneumoniae. Laboratory diagnostic methods include molecular assay, serological antibody detection, rapid antigen detection and isolation and culture. Polymerase chain reaction (PCR) is the gold standard with high sensitivity and specificity. The serological antibody can detect various immune antibodies qualitatively or quantitatively in serum. Rapid antigen can be detected faster, with no equipment environment requirements, which can be used for the early diagnosis of MP infection. While the culture growth cycle is long and insensitive, not recommended for routine diagnosis. Macrolides were the preferred drug for children with MPP, while the drug resistance rate was rising in China. Tetracycline can be substituted but was not recommended for children under 8 years of age, quinolone drugs are not necessary, severe MPP can be combined with glucocorticoids, involving the nervous or immune system can choose gamma globulin. Other treatments for MPP including symptomatic treatment which can alleviate symptoms, improve lung function and improve prognosis. A safe and effective vaccine needed to be developed which can provide protective immunity to children and will reduce the incidence of MPP.
Collapse
Affiliation(s)
- Li Gao
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanhong Sun
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
10
|
Wang H, Zhang Y, Zhao C, Peng Y, Song W, Xu W, Wen X, Liu J, Yang H, Shi R, Zhao S. Serum IL-17A and IL-6 in paediatric Mycoplasma pneumoniae pneumonia: implications for different endotypes. Emerg Microbes Infect 2024; 13:2324078. [PMID: 38407218 PMCID: PMC10997354 DOI: 10.1080/22221751.2024.2324078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
Paediatric Mycoplasma pneumoniae pneumonia (MPP) is a heterogeneous disease with a diverse spectrum of clinical phenotypes. No studies have demonstrated the relationship between underlying endotypes and clinical phenotypes as well as prognosis about this disease. Thus, we conducted a multicentre prospective longitudinal study on children hospitalized for MPP between June 2021 and March 2023, with the end of follow-up in August 2023. Blood samples were collected and processed at multiple time points. Multiplex cytokine assay was performed to characterize serum cytokine profiles and their dynamic changes after admission. Cluster analysis based on different clinical phenotypes was conducted. Among the included 196 patients, the levels of serum IL-17A and IL-6 showed remarkable variabilities. Four cytokine clusters based on the two cytokines and four clinical groups were identified. Significant elevation of IL-17A mainly correlated with diffuse bronchiolitis and lobar lesion by airway mucus hypersecretions, while that of IL-6 was largely associated with lobar lesion which later developed into lung necrosis. Besides, glucocorticoid therapy failed to inhibit IL-17A, and markedly elevated IL-17A and IL-6 levels may correlate with lower airway obliterans. Our study provides critical relationship between molecular signatures (endotypes) and clustered clinical phenotypes in paediatric patients with MPP.
Collapse
Affiliation(s)
- Heng Wang
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Yanli Zhang
- Division of Pulmonology, Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
| | - Chengsong Zhao
- Department of Infectious Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Yun Peng
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Wenqi Song
- Department of Clinical Laboratory, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Weihan Xu
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Xiaohui Wen
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Jinrong Liu
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Haiming Yang
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Ruihe Shi
- Division of Pulmonology, Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
| | - Shunying Zhao
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| |
Collapse
|
11
|
Ma X, Tian L, Xu S, Shang J. Tigecycline combined with bronchoscopic interventions in the treatment of macrolide-unresponsive Mycoplasma penumoniae pneumonia: A case report. Heliyon 2024; 10:e40058. [PMID: 39553583 PMCID: PMC11566845 DOI: 10.1016/j.heliyon.2024.e40058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 10/29/2024] [Accepted: 10/31/2024] [Indexed: 11/19/2024] Open
Abstract
Mycoplasma penumoniae (MP) is a common etiological agent of community-acquired pneumonia. However, there has been an increasing incidence of macrolide-unresponsive Mycoplasma penumoniae pneumonia (MUMPP) in recent years. The treatment of MUMPP requires further investigation. In this report, we describe a case of MUMPP complicated by secondary spontaneous pneumothorax. The patient was unresponsive to initial macrolide treatment and his pneumonia worsened with increasing hypoxemic respiratory failure. However, after receiving a novel tetracycline and a carbapenem antibiotic as anti-infective agents, glucocorticoid for anti-inflammatory and bronchoscopic interventions to clear the bronchial casts, his fever and hypoxia resolved, and his lung lesions had significantly improved. Symptomatic supportive measures, including supplemental oxygen, was provided for the management of spontaneous pneumothorax developed twenty days after discharge. At follow-up, he did not experience any more initial symptoms. All indexes remained normal for half a year. This study represents the initial investigation into the utilization of tigecycline in conjunction with bronchoscopic interventions including bronchoalveolar lavage (BAL) and bronchoscopic cryotherapy (BC) in the treatment of MUMPP, glucocorticoid can be considered for anti-inflammatory purposes, especially for patients with severe pneumonia. The findings from this case offer valuable insights into a potential therapeutic approach for individuals afflicted with MUMPP.
Collapse
Affiliation(s)
- Xinyue Ma
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, China
| | - Lei Tian
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, China
| | - Shuyun Xu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, China
| | - Jin Shang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, China
| |
Collapse
|
12
|
Song X, Zhou N, Lu S, Gu C, Qiao X. New-generation tetracyclines for severe macrolide-resistant Mycoplasma pneumoniae pneumonia in children: a retrospective analysis. BMC Infect Dis 2024; 24:1166. [PMID: 39407159 PMCID: PMC11481790 DOI: 10.1186/s12879-024-10070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 10/08/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Macrolide-resistant Mycoplasma pneumoniae (MRMP) strains are increasingly prevalent, leading to a rise in severe Mycoplasma pneumoniae pneumonia incidence annually, which poses a significant threat to children's health. This study aimed to compare the effectiveness and safety of oral minocycline and doxycycline for the treatment of severe MRMP pneumonia in children. METHODS This retrospective analysis included children treated for severe MRMP pneumonia at the Pediatric Department of Tongji Hospital, Shanghai, China, between September 2023 and January 2024 using minocycline and doxycycline. The patients were divided into four groups according to treatment: oral doxycycline alone (DOX group), oral minocycline alone (MIN group), oral doxycycline with intravenous glucocorticoids (DOXG group), and oral minocycline with intravenous glucocorticoids (MING group). Student's t-test, Mann-Whitney U test, and χ2 or Fisher's exact tests were used for group comparisons. RESULTS A total of 165 patients were included in this study: 84 received minocycline, and 81 received doxycycline. The DOX group had higher fever resolution rates within 24, 48, and 72 h compared to the MIN group (63.2% vs. 31.8%, 79.0% vs. 63.6%, and 100% vs. 90.9%, respectively; all p < 0.05). The DOXG group showed higher fever resolution rates within 24 and 48 h than the MING group (92.3% vs. 83.4%, 100% vs. 92.7%, all p > 0.05). There were no statistically significant differences in time to imaging improvement, cough improvement, and disappearance of wet rales between groups, regardless of glucocorticoid combination. The longer the duration of fever prior to tetracycline therapy, the greater the likelihood of hypoxemia (p = 0.039) and a greater than two-fold elevation in the D-dimer level (p = 0.004).Univariate binary logistic regression model analysis revealed that CRP and erythrocyte sedimentation rate at disease onset were associated with defervescence within 24 h after treatment with tetracyclines alone (p = 0.020, p = 0.027), with erythrocyte sedimentation rate also influencing defervescence within 48 h (p = 0.022). CONCLUSION Doxycycline treatment resulted in a higher rate of defervescence than minocycline. Prompt treatment reduced the probability of pleural effusion, hypoxemia, pulmonary atelectasis, and D-dimer levels > 2 times the reference value.
Collapse
Affiliation(s)
- Xiaoxiao Song
- Department of Pediatrics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Ning Zhou
- Department of Pediatrics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Shuanglong Lu
- Department of Pediatrics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Changjuan Gu
- Department of Pediatrics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Xiaohong Qiao
- Department of Pediatrics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
| |
Collapse
|
13
|
Zhang YX, Li Y, Wang Y, Ren YF, Yang Y, Qi J, Yang H, Liang X, Zhang RF. Prospective cohort study on the clinical significance of interferon-γ, D-dimer, LDH, and CRP tests in children with severe mycoplasma pneumonia. Medicine (Baltimore) 2024; 103:e39665. [PMID: 39465799 PMCID: PMC11479529 DOI: 10.1097/md.0000000000039665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 08/22/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND Mycoplasma pneumoniae is a significant cause of respiratory infections in children, often leading to severe pneumonia. This study aimed to assess the clinical relevance of interferon-gamma (interferon-γ), D-dimer, lactate dehydrogenase (LDH), and C-reactive protein (CRP) as biomarkers in the severity of mycoplasma pneumonia in pediatric patients. METHODS In this prospective study, 203 pediatric patients with mycoplasma pneumonia were classified into mild (123 patients) and severe (80 patients) groups. Biomarkers including interferon-γ, D-dimer, LDH, and CRP were measured and analyzed. Statistical methods employed included Pearson and Spearman correlation analyses, logistic regression, and receiver operating characteristic curve analysis. RESULTS The severe group exhibited significantly higher median and interquartile ranges for interferon-γ, D-dimer, LDH, and CRP compared to the mild group. Logistic regression identified IL-10, IL-6, interferon-γ, tumor necrosis factor-alpha, D-dimer, and LDH as independent predictors of severity, with the model achieving 92% accuracy. Receiver operating characteristic curve analysis showed optimal diagnostic efficacy for interferon-γ, D-dimer, and LDH, with the best threshold values being 8.11, 0.64, and 379, respectively. A significant positive correlation was observed between IL-6 and LDH, as well as between interferon-γ and D-dimer. CONCLUSION This study showed that interferon-γ >8.11, D-dimer >0.64, and LDH >379 have an important role in the assessment of severe mycoplasma pneumonia.
Collapse
Affiliation(s)
- Yu-xiang Zhang
- Department of Allergy, Gansu Maternal and Child Health Hospital, First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yang Li
- Department of Allergy, Gansu Maternal and Child Health Hospital, First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yong Wang
- Department of Allergy, Gansu Maternal and Child Health Hospital, First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - You-feng Ren
- Department of Allergy, Gansu Maternal and Child Health Hospital, First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yue Yang
- Department of Allergy, Gansu Maternal and Child Health Hospital, First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jing Qi
- Department of Allergy, Gansu Maternal and Child Health Hospital, First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Hui Yang
- Department of Allergy, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Xuan Liang
- Department of Allergy, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Rong-fang Zhang
- Department of Allergy, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| |
Collapse
|
14
|
Yan M, Tao R, Li S, Xiong J, Xiang J. Clinical characteristics and logistic regression analysis of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. Eur J Clin Microbiol Infect Dis 2024; 43:1825-1835. [PMID: 39017999 DOI: 10.1007/s10096-024-04902-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE To investigate macrolide-resistant Mycobacterium pneumoniae (MRMP) pneumonia in children and construct a logistic regression model for mutations in the Mycoplasma pneumoniae drug-resistant gene. METHODS Clinical data of 281 children were analyzed. Sequencing confirmed a mutation at the A2063G locus of the 23 S rRNA gene in 227 children (A2063G group); 54 children showed no mutations (non-MRMP [NMRMP] group). We compared clinical features, laboratory tests, imaging, and bronchoscopy results and constructed a multifactorial logistic regression model to analyze risk and protective factors. RESULTS The A2063G group had longer durations of fever and hospitalization before admission, a higher proportion of treatment with sodium methylprednisolone succinate (MPS)/dexamethasone, longer time to discontinue hormones, and higher probability of combined infections. Monocyte percentage was significantly higher in the A2063G group. Imaging suggested a higher incidence of infections in the right lung compared to both lungs. Univariate analysis revealed fever duration before admission, hormone dose and duration, monocyte percentage, and mixed infections as risk factors for Mycoplasma pneumoniae infection with the A2063G mutation. The logistic regression model showed that mixed infections were an independent risk factor for the A2063G locus mutation, whereas hormone dose was a protective factor. CONCLUSION A prevalence of macrolide resistance of 80.8% among children was observed in the region. Logistic regression analysis revealed that co-infection with other respiratory pathogens is an independent risk factor for the development of resistance genes, while the use of hormone dosage acts as a protective factor.
Collapse
Affiliation(s)
- Mengzhen Yan
- Affiliated Renhe Hospital of China Three Gorges University, Neonatology Wujiagang District, Yichang City, Hubei Province, China
| | - Ran Tao
- Affiliated Renhe Hospital of China Three Gorges University, Neonatology Wujiagang District, Yichang City, Hubei Province, China
| | - Shigang Li
- Affiliated Renhe Hospital of China Three Gorges University, Neonatology Wujiagang District, Yichang City, Hubei Province, China
| | - Jinwen Xiong
- Affiliated Renhe Hospital of China Three Gorges University, Neonatology Wujiagang District, Yichang City, Hubei Province, China
| | - Jinbo Xiang
- Affiliated Renhe Hospital of China Three Gorges University, Neonatology Wujiagang District, Yichang City, Hubei Province, China.
| |
Collapse
|
15
|
Zheng Y, Mao G, Dai H, Li G, Liu L, Chen X, Zhu Y. Early predictors of delayed radiographic resolution of lobar pneumonia caused by Mycoplasma pneumoniae in children: a retrospective study in China. BMC Infect Dis 2024; 24:414. [PMID: 38641804 PMCID: PMC11027392 DOI: 10.1186/s12879-024-09289-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/03/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lobar pneumonia caused by Mycoplasma pneumoniae is a relatively difficult-to-treat pneumonia in children. The time of radiographic resolution after treatment is variable, a long recovery time can result in several negative effects, and it has attracted our attention. Therefore, exploring factors associated with delayed radiographic resolution will help to identify these children at an early stage and prepare for early intervention. METHODS The data of 339 children with lobar pneumonia caused by Mycoplasma pneumoniae were collected from the Department of Pediatrics of Fu Yang People's Hospital, China from January 2021 to June 2022. After discharge, the children were regularly followed up in the outpatient department and on the WeChat platform for > 8 weeks. According to whether pulmonary imaging (chest radiography or plain chest computed tomography) returned to normal within 8 weeks, the children were divided into the delayed recovery group (DRG) (n = 69) and the normal recovery group (NRG) (n = 270). The children's general information, laboratory examination findings, bronchoscopy results, and imaging findings were retrospectively analyzed. Single-factor analysis was performed to identify the risk factors for delayed radiographic resolution of lobar pneumonia caused by Mycoplasma pneumoniae, and the factors with statistically significant differences underwent multiple-factor logistic regression analysis. Receiver operating characteristic (ROC) analysis was then performed to calculate the cutoff value of early predictive indicators of delayed radiographic resolution. RESULTS Single-factor analysis showed that the following were significantly greater in the DRG than NRG: total fever duration, the hospitalization time, C-reactive protein (CRP) level, lactate dehydrogenase (LDH) level, D-dimer level, pulmonary lesions involving two or more lobes, a large amount of pleural effusion, the time to interventional bronchoscopy, and mucus plugs formation. Multivariate logistic regression analysis showed that the hospitalization time, CRP level, LDH level, pulmonary lesions involving two or more lobes, and a large amount of pleural effusion were independent risk factors for delayed radiographic resolution of lobar pneumonia caused by Mycoplasma pneumoniae. The cutoff values on the receiver operating characteristic curve were a hospitalization time of ≥ 10.5 days, CRP level of ≥ 25.92 mg/L, and LDH level of ≥ 378 U/L. CONCLUSION If patients with lobar pneumonia caused by Mycoplasma pneumoniae have a hospitalization time of ≥ 10.5 days, CRP level of ≥ 25.92 mg/L, and LDH level ≥ 378 U/L, the time of radiographic resolution is highly likely to exceed 8 weeks. Pediatricians must maintain a high level of vigilance for these factors, control the infection as early as possible, strengthen airway management, and follow up closely to avoid complications and sequelae of Mycoplasma pneumoniae pneumonia.
Collapse
Affiliation(s)
- Yu Zheng
- Department of Pediatrics, Fu Yang People's Hospital, No.501, Sanqing Road, Yingzhou District, 236000, Fuyang, Anhui Province, China
| | - Guoshun Mao
- Department of Pediatrics, Fu Yang People's Hospital, No.501, Sanqing Road, Yingzhou District, 236000, Fuyang, Anhui Province, China
| | - Hongchen Dai
- Department of Pediatrics, Fu Yang People's Hospital, No.501, Sanqing Road, Yingzhou District, 236000, Fuyang, Anhui Province, China
| | - Guitao Li
- Department of Pediatrics, Fu Yang People's Hospital, No.501, Sanqing Road, Yingzhou District, 236000, Fuyang, Anhui Province, China
| | - Liying Liu
- Department of Pediatrics, Fu Yang People's Hospital, No.501, Sanqing Road, Yingzhou District, 236000, Fuyang, Anhui Province, China
| | - Xiaying Chen
- Department of Pediatrics, Fu Yang People's Hospital, No.501, Sanqing Road, Yingzhou District, 236000, Fuyang, Anhui Province, China
| | - Ying Zhu
- Department of Pediatrics, Fu Yang People's Hospital, No.501, Sanqing Road, Yingzhou District, 236000, Fuyang, Anhui Province, China.
| |
Collapse
|
16
|
Song Z, Jia G, Luo G, Han C, Zhang B, Wang X. Global research trends of Mycoplasma pneumoniae pneumonia in children: a bibliometric analysis. Front Pediatr 2023; 11:1306234. [PMID: 38078315 PMCID: PMC10704248 DOI: 10.3389/fped.2023.1306234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/13/2023] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Mycoplasma pneumoniae pneumonia (MPP), attributable to Mycoplasma pneumoniae (MP), represents a predominant form of community-acquired pneumonia in pediatric populations, thereby posing a significant threat to pediatric health. Given the burgeoning volume of research literature associated with pediatric MPP in recent years, it becomes imperative to undertake a bibliometric analysis aimed at delineating the current research landscape and emerging trends, thereby furnishing a framework for subsequent investigations. METHODS A comprehensive literature search targeting pediatric MPP was conducted in the Web of Science Core Collection. After the removal of duplicate entries through Endnote software, the remaining articles were subject to scientometric analysis via Citespace software, VOSviewer software and R language, focusing on variables such as publication volume, contributing nations, institutions and authors, references and keywords. RESULTS A total of 1,729 articles pertinent to pediatric MPP were included in the analysis. China and the United States emerged as the nations with the highest publication output. Italian scholar Susanna Esposito and Japanese scholar Kazunobu Ouchi were the most influential authors in the domain of pediatric MPP. Highly-cited articles primarily focused on the epidemiological investigation of pediatric MPP, the clinical characteristics and treatment of macrolide-resistant MPP, and biomarkers for refractory Mycoplasma pneumoniae pneumonia (RMPP). From the corpus of 1,729 articles, 636 keywords were extracted and categorized into ten clusters: Cluster #0 centered on molecular-level typing of macrolide-resistant strains; Cluster #1 focused on lower respiratory tract co-infections; Clusters #2 and #6 emphasized other respiratory ailments caused by MP; Cluster #3 involved biomarkers and treatment of RMPP; Clusters #4 and #9 pertained to extrapulmonary complications of MPP, Clusters #5 and #7 addressed etiological diagnosis of MPP, and Cluster #8 explored pathogenic mechanisms. CONCLUSIONS The past few years have witnessed extensive attention directed towards pediatric MPP. Research in pediatric MPP principally revolves around diagnostic techniques for MP, macrolide resistance, complications of MPP, treatment and diagnosis of RMPP, and elucidation of pathogenic mechanisms. The present study provides pediatric clinicians and researchers with the research status and focal points in this field, thereby guiding the orientation of future research endeavors.
Collapse
Affiliation(s)
- Zhe Song
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guangyuan Jia
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guangzhi Luo
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chengen Han
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Baoqing Zhang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiao Wang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| |
Collapse
|
17
|
Martínez JL, Baquero F. What are the missing pieces needed to stop antibiotic resistance? Microb Biotechnol 2023; 16:1900-1923. [PMID: 37417823 PMCID: PMC10527211 DOI: 10.1111/1751-7915.14310] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/08/2023] Open
Abstract
As recognized by several international agencies, antibiotic resistance is nowadays one of the most relevant problems for human health. While this problem was alleviated with the introduction of new antibiotics into the market in the golden age of antimicrobial discovery, nowadays few antibiotics are in the pipeline. Under these circumstances, a deep understanding on the mechanisms of emergence, evolution and transmission of antibiotic resistance, as well as on the consequences for the bacterial physiology of acquiring resistance is needed to implement novel strategies, beyond the development of new antibiotics or the restriction in the use of current ones, to more efficiently treat infections. There are still several aspects in the field of antibiotic resistance that are not fully understood. In the current article, we make a non-exhaustive critical review of some of them that we consider of special relevance, in the aim of presenting a snapshot of the studies that still need to be done to tackle antibiotic resistance.
Collapse
Affiliation(s)
| | - Fernando Baquero
- Ramón y Cajal Institute for Health Research (IRYCIS), Department of MicrobiologyRamón y Cajal University Hospital, CIBER en Epidemiología y Salud Pública (CIBERESP)MadridSpain
| |
Collapse
|