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. 2018 Oct 26:6:296.
doi: 10.3389/fped.2018.00296. eCollection 2018.

Low Bacterial Co-infection Invalidates the Early Use of Non-anti- Mycoplasma pneumoniae Antibiotics in Pediatric Refractory Mycoplasma pneumoniae Pneumonia Patients

Jin-Rong Liu  1 , Jie Lu  2   3 , Fang Dong  4 , Hui-Min Li  1 , Hui Liu  1 , Xiao-Lei Tang  1 , Yong-Li Guo  2   3 , Shun-Ying Zhao  1
Affiliations

Low Bacterial Co-infection Invalidates the Early Use of Non-anti- Mycoplasma pneumoniae Antibiotics in Pediatric Refractory Mycoplasma pneumoniae Pneumonia Patients

Jin-Rong Liu et al. Front Pediatr. .

Abstract

Background: Childhood refractory mycoplasma pneumoniae (MP) pneumonia (RMPP) is a lung disease with elevated level of C-reactive protein and severe clinical and radiological deterioration. Whether bacterial co-infection contributes to disease of RMPP and whether inclusion of non-anti-MP antibiotics in treatment regimen would benefit RMPP patients remains elusive. Methods: We retrospectively reviewed the medical records of 675 RMPP children. Traditional bacterial culture and next generation sequencing (NGS) were used to detect bacteria in bronchoalveolar lavage fluid in all the 675 patients and 18 patients respectively. Antibiotics used and clinical outcomes were analyzed along with other clinical measurements. Results: Positive bacterial cultures were only found in 18 out of 675 cases (2.67%) and NGS analyses of another 18 cases did not revealed positive bacterial infection, which were consistent with the results of bacterial cultures. Non-anti-MP antibiotics were utilized in 630 cases (93.33%), even last-line antibiotics, such as glycopeptides or carbapenems, were frequently used. Conclusion: Bacterial co-infection in RMPP was rare and non-anti-MP antibiotics didn't show any efficacy for early treatment of RMPP patients, which may provide a rationale for restricting the use of non-anti-MP antibiotics in RMPP patients and preventing antibiotic resistance globally.

Keywords: Mycoplasma pneumoniae pneumonia (MPP); NGS (next generation sequencing); antibiotics–rational therapy; bacterial infection; refractory.

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Figures

Figure 1
Figure 1
Fiberoptic bronchoscopy revealed the obliteration of the lumen of bronchial branches, bronchial segments, or bronchial subsegments.
Figure 2
Figure 2
Fiberoptic bronchoscopy revealed mucous plug which suggested airway hypersecretion or airway obstruction in RMPP patients.
Figure 3
Figure 3
Chest imaging revealed high-density consolidation in right lung (A,B) with right pleural effusion (C) in RMPP patients.
Figure 4
Figure 4
The annual case number of RMPP between January 2008 and December 2015. The number of patients enrolled in 2013 (152 cases) was the most followed by 2012 (106 cases), while only 49 patients were enrolled in 2014, which coincided with a RMPP outbreak around 2012-2013.
Figure 5
Figure 5
Flow diagram of patient enrollment and treatment.
See this image and copyright information in PMC

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