Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia

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.

Keywords: Asia; Mycoplasma pneumoniae; antimicrobial resistance; bacteria; children; macrolide resistance; pneumonia.

Figure 1

Flow diagram of selection process for meta-analysis of macrolide-resistant Mycoplasma pneumoniae infections in pediatric community-acquired pneumonia.

Figure 2

Forest plots of difference in total febrile days between MRMP and MSMP in meta-analysis of MRMP infections in pediatric community-acquired pneumonia. MD, mean difference; MRMP, macrolide-resistant Mycoplasma pneumoniae; MSMP, macrolide-sensitive Mycoplasma pneumoniae.

Figure 3

Forest plots comparing the pooled odds ratio of fever lasting for 48 hours after macrolide treatment between MRMP and MSMP in meta-analysis of MRMP infections in pediatric community-acquired pneumonia. MRMP, macrolide-resistant Mycoplasma pneumoniae; MSMP, macrolide-sensitive Mycoplasma pneumoniae; OR, odds ratio.

Figure 4

Forest plots depicting the defervescence time (days) after macrolide treatment in meta-analysis of MRMP infections in pediatric community-acquired pneumonia. Subgroup analysis was performed according to country. MD, mean difference; MRMP, macrolide-resistant Mycoplasma pneumoniae; MSMP, macrolide-sensitive Mycoplasma pneumoniae.

Figure 5

Forest plots comparing MRMP and MSMP by the pooled odds ratio of changing antibiotics in meta-analysis of MRMP infections in pediatric community-acquired pneumonia. MRMP, macrolide-resistant Mycoplasma pneumoniae; MSMP, macrolide-sensitive Mycoplasma pneumoniae; OR, odds ratio.

Figure 6

The duration difference (days) of antibiotic use between MRMP and MSMP infections in meta-analysis of MRMP infections in pediatric community-acquired pneumonia. MD, mean difference; MRMP, macrolide-resistant Mycoplasma pneumoniae; MSMP, macrolide-sensitive Mycoplasma pneumoniae.