1
|
Yang S, Lu S, Guo Y, Luan W, Liu J, Wang L. A comparative study of general and severe mycoplasma pneumoniae pneumonia in children. BMC Infect Dis 2024; 24:449. [PMID: 38671341 PMCID: PMC11046970 DOI: 10.1186/s12879-024-09340-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: 02/22/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES The increasing prevalence of severe Mycoplasma pneumoniae pneumonia (SMPP) poses a significant threat to the health of children. This study aimed to characterise and assess the outcomes in children with SMPP. METHODS We retrospectively analysed children hospitalised for M. pneumoniae pneumonia (MPP) between January and December 2022. Retrospectively, demographic, clinical, underlying diseases, laboratory and radiological findings, and treatment outcomes were collected and analysed. Disease severity was defined as severe or general according to the Guideline for diagnosis and treatment of community-acquired pneumonia in children (2019 version). RESULTS Over a 12-month observation period, 417 children with MPP were enrolled, 50.6% (211/417) of whom had SMPP, with the peak incidence observed in winter. Of the 211 children with SMPP, 210 were treated and discharged with improvement, while one child with congenital heart disease died of cardioembolic stroke. A significantly higher proportion of patients with SMPP had underlying diseases, extrapulmonary complications (myocardial and digestive system involvement), and bacterial co-infection. A total of 25 (12%) children with SMPP received mechanical ventilation. The median duration of mechanical ventilation was 3 days. All children were treated with macrolide antibiotic. A significantly higher proportion of patients with SMPP received antibiotic other than macrolides, methylprednisolone sodium succinate, intravenous immunoglobulin and anticoagulation, compared with patients with general MPP (GMPP). Children with SMPP had significantly higher levels of white blood cells, neutrophil percentage, C-reactive protein, procalcitonin, interferon-γ, interleukin (IL)-2, IL-5, IL-6, IL-8, IL-10 and significantly lower percentages of lymphocytes, monocytes, and natural killer cells, compared with GMPP group. CONCLUSION Our findings suggest that severely ill children have more pronounced inflammatory reaction and extrapulmonary complications. For effective management of children with SMPP, hormonal, prophylactic, anticoagulant therapy, as well as the use of antibiotics other than macrolides for bacterial co-infections, could be incorporated into treatment regimens.
Collapse
Affiliation(s)
- Shuo Yang
- Institute of Pediatric Research, Children's Hospital of Hebei, 133 Jianhua South Street, Shijiazhuang, 050031, China
| | - Sukun Lu
- Department of Respiratory, Children's Hospital of Hebei, Shijiazhuang, 050031, China
| | - Yinghui Guo
- Department of Laboratory Medicine, Children's Hospital of Hebei, Shijiazhuang, 050031, China
- Children's Hospital of Hebei, Shijiazhuang, 050031, China
| | - Wenjun Luan
- Department of Respiratory, Children's Hospital of Hebei, Shijiazhuang, 050031, China
| | - Jianhua Liu
- Department of Respiratory, Children's Hospital of Hebei, Shijiazhuang, 050031, China
| | - Le Wang
- Institute of Pediatric Research, Children's Hospital of Hebei, 133 Jianhua South Street, Shijiazhuang, 050031, China.
| |
Collapse
|
2
|
Jiang Y, Dou H, Xu B, Xu B, Zhou W, Wang H, Ge L, Hu Y, Han X, Qin X, Li J, Ye L, Wu L, Zuo H, Zhang Q, Liu L, Hu W, Shao J, Yin Q, Han L, Fu X, Dong X, Dong Y, Fu Y, Zhao M, Sun Q, Huo J, Liu D, Liu W, Li Y, Wang Y, Xin D, Shen K. Macrolide resistance of Mycoplasma pneumoniae in several regions of China from 2013 to 2019. Epidemiol Infect 2024; 152:e75. [PMID: 38634450 PMCID: PMC11094376 DOI: 10.1017/s0950268824000323] [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: 08/25/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 04/19/2024] Open
Abstract
This paper retrospectively analysed the prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) in some parts of China. Between January 2013 and December 2019, we collected 4,145 respiratory samples, including pharyngeal swabs and alveolar lavage fluid. The highest PCR-positive rate of M. pneumoniae was 74.5% in Beijing, the highest resistance rate was 100% in Shanghai, and Gansu was the lowest with 20%. The highest PCR-positive rate of M. pneumoniae was 74.5% in 2013, and the highest MRMP was 97.4% in 2019; the PCR-positive rate of M. pneumoniae for adults in Beijing was 17.9% and the MRMP was 10.48%. Among the children diagnosed with community-acquired pneumonia (CAP), the PCR-positive and macrolide-resistant rates of M. pneumoniae were both higher in the severe ones. A2063G in domain V of 23S rRNA was the major macrolide-resistant mutation, accounting for more than 90%. The MIC values of all MRMP to erythromycin and azithromycin were ≥ 64 μg/ml, and the MICs of tetracycline and levofloxacin were ≤ 0.5 μg/ml and ≤ 1 μg/ml, respectively. The macrolide resistance varied in different regions and years. Among inpatients, the macrolide-resistant rate was higher in severe pneumonia. A2063G was the common mutation, and we found no resistance to tetracycline and levofloxacin.
Collapse
Affiliation(s)
- Yue Jiang
- Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Haiwei Dou
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bo Xu
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Baoping Xu
- Beijing Children’s Hospital, Capital Medical University, China National Clinical Research Center of Respiratory Diseases, National Center for Children’s Health, Beijing, China
| | - Wei Zhou
- Peking University Third Hospital, Beijing, China
| | - Hong Wang
- Civil Aviation General Hospital, Beijing, China
| | - Lixia Ge
- China Meitan General Hospital, Beijing, China
| | - Yinghui Hu
- New Century International hospital for Children, Beijing, China
| | - Xiaohua Han
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuanguang Qin
- Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Jing Li
- Beijing Changping District Integrated Traditional Chinese and Western Medicine Hospital, Beijing, China
| | - Leping Ye
- Peking University First Hospital, Beijing, China
| | - Liqun Wu
- Dongfang Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Huimin Zuo
- The First Hospital of Tsinghua University, Beijing, China
| | - Qi Zhang
- China-Japan Friendship Hospital, Beijing, China
| | - Ling Liu
- Peking University Third Hospital, Beijing, China
| | - Wenjuan Hu
- Civil Aviation General Hospital, Beijing, China
| | - Junyan Shao
- China Meitan General Hospital, Beijing, China
| | - Qiaomian Yin
- New Century International hospital for Children, Beijing, China
| | - Lina Han
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoyan Fu
- Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Xiaopei Dong
- Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Yan Dong
- Beijing Changping District Integrated Traditional Chinese and Western Medicine Hospital, Beijing, China
| | - Yulin Fu
- Beijing Changping District Integrated Traditional Chinese and Western Medicine Hospital, Beijing, China
| | | | - Qing Sun
- Peking University First Hospital, Beijing, China
| | - Jingwei Huo
- Dongfang Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Die Liu
- China-Japan Friendship Hospital, Beijing, China
| | - Wenkao Liu
- Beijing Changping District Integrated Traditional Chinese and Western Medicine Hospital, Beijing, China
| | - Yunjuan Li
- New Century International hospital for Children, Beijing, China
| | - Yang Wang
- New Century International hospital for Children, Beijing, China
| | - Deli Xin
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kunling Shen
- Beijing Children’s Hospital, Capital Medical University, China National Clinical Research Center of Respiratory Diseases, National Center for Children’s Health, Beijing, China
- Shenzhen Children′s Hospital, Shenzhen, Guangdong Province, China
| |
Collapse
|
3
|
Huang X, Luo Y, Wang J, Zhang X, Chen L, Wu R, Xue Z, Gu H, Li D, Tang H, Qin H, Zhao D, Liu F. Integrative study of pulmonary microbiome, transcriptome and clinical outcomes in Mycoplasma pneumoniae pneumonia. Respir Res 2024; 25:35. [PMID: 38238712 PMCID: PMC10795342 DOI: 10.1186/s12931-024-02687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND This study aimed to investigate the interactions among three core elements of respiratory infection-pathogen, lung microbiome, and host response-and their avocation with the severity and outcomes of Mycoplasma pneumoniae pneumonia (MPP) in children. METHODS We prospectively collected bronchoalveolar lavage fluid from a cohort of 41 children with MPP, including general MPP (GMPP) and complicated MPP (CMPP), followed by microbiome and transcriptomic analyses to characterize the association among pathogen, lung microbiome, and host response and correlate it with the clinical features and outcomes. RESULTS The lung microbiome of patients with CMPP had an increased relative abundance of Mycoplasma pneumoniae (MP) and reduced alpha diversity, with 76 differentially expressed species. Host gene analysis revealed a key module associated with neutrophil function and several inflammatory response pathways. Patients with a high relative abundance of MP, manifested by a specific lung microbiome and host response type, were more prone to CMPP and had a long imaging recovery time. CONCLUSION Patients with CMPP have a more disrupted lung microbiome than those with GMPP. MP, lung microbiome, and host response interacts with each other and are closely related to disease severity and outcomes in children with MPP.
Collapse
Affiliation(s)
- Xia Huang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Yingying Luo
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Jing Wang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xuefang Zhang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Lei Chen
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Ruxi Wu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Zhengyang Xue
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Haiyan Gu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Daiying Li
- Vision Medicals Center for Infectious Diseases, Guangzhou, 510705, China
| | - Heng Tang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Houbing Qin
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Deyu Zhao
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| | - Feng Liu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| |
Collapse
|
4
|
Wu L, Zhang J, Zhang HM, Wang CY. Study on red blood cell distribution width in children with severe Mycoplasma pneumoniae pneumonia. Biomark Med 2024; 18:69-77. [PMID: 38440878 DOI: 10.2217/bmm-2023-0671] [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] [Indexed: 03/06/2024] Open
Abstract
Background: This study aimed to investigate the clinical value of the red blood cell distribution width (RDW) in severe Mycoplasma pneumoniae pneumonia (MPP). Methods: A total of 185 children with diagnosed severe MPP were included. The patients' case records and laboratory examination data were analyzed retrospectively. The children were grouped into quartiles based on RDW. Results: Univariate analysis revealed that RDW was significantly correlated with the Pediatric Risk of Mortality (PRISM) III score, Sepsis-Related Organ Failure Assessment score, incidence of invasive intubation and 30-day in-hospital mortality. After adjustment for the severity of illness, multivariate analysis revealed that the PRISM III score and RDW were factors independently associated with 30-day in-hospital mortality. Conclusion: This study revealed that RDW could be correlated with the long-term prognosis and severity of severe MPP.
Collapse
Affiliation(s)
- Lin Wu
- Department of Pediatrics, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology & Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, 350001, China
- Department of Pediatrics, Fujian Maternity and Children Hospital, College of Clinical Medicine for Obstetrics & Gynecology & Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, 350001, China
| | - Jinyan Zhang
- College of Clinical Medicine for Obstetrics & Gynecology & Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, 350001, China
| | - Hui-Min Zhang
- Department of Pediatrics, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology & Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, 350001, China
| | - Cheng-Yi Wang
- Department of Pediatrics, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology & Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, 350001, China
- Department of Pediatrics, Fujian Maternity and Children Hospital, College of Clinical Medicine for Obstetrics & Gynecology & Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, 350001, China
| |
Collapse
|
5
|
Dian D, Zhang W, Lu M, Zhong Y, Huang Y, Chen G, Chen Z, Yu L, Sun J. Clinical Efficacy of Ulinastatin Combined with Azithromycin in the Treatment of Severe Pneumonia in Children and the Effects on Inflammatory Cytokines and Oxidative Stress: A Retrospective Cohort Study. Infect Drug Resist 2023; 16:7165-7174. [PMID: 38023407 PMCID: PMC10640813 DOI: 10.2147/idr.s428900] [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: 07/04/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose This retrospective cohort study aimed to evaluate the clinical efficacy of ulinastatin (UTI) and azithromycin (AZM) combination therapy in treating severe pneumonia in children and its impact on inflammatory cytokines and oxidative stress. Patients and Methods This retrospective cohort study was conducted from January 1, 2019, to January 1, 2021, involving pediatric patients diagnosed with severe mycoplasma pneumonia (SMPP). The pediatric patients were divided into two groups: those receiving UTI and AZM combination therapy (treatment group) and those receiving azithromycin alone (control group). We compared the two groups regarding clinical data, disease outcomes, inflammatory cytokines, and oxidative stress levels. Results Baseline characteristics did not significantly differ between the two groups. UTI, in combination with AZM, significantly improved blood oxygen levels, inflammatory infection markers, and relevant clinical symptoms in patients with SMPP on the 3rd day of treatment. Additionally, it significantly reduced the levels of inflammatory cytokines TNF-a, IL-6, IL-1β, and IL-10, as well as oxidative stress markers GSH and SOD. Conclusion Combining UTI and AZM can rapidly alleviate clinical symptoms and effectively control the progression of patients with SMPP. Therefore, this treatment approach deserves consideration for clinical promotion and utilization.
Collapse
Affiliation(s)
- Dongchun Dian
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Weilong Zhang
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Minjun Lu
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Yong Zhong
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Yurong Huang
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Guiling Chen
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Zhangquan Chen
- Guangdong Medical University, Guangdong, 510000, People’s Republic of China
| | - Luxin Yu
- Guangdong Medical University, Guangdong, 510000, People’s Republic of China
| | - Jianbo Sun
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| |
Collapse
|