Assessment of variables associated with prolonged admission duration in children with Mycoplasma pneumoniae pneumonia

Abstract

Introduction: Macrolide-resistant Mycoplasma pneumoniae (MRMP) has become prevalent in children. This study investigated the clinical and laboratory variables of MRMP and macrolide-sensitive M. pneumoniae (MSMP) and identified factors associated with prolonged hospital admission in children.

Methods: A prospective multicenter study was conducted in 1063 children <18 years old in July 2018-June 2020. The 454 had a positive M. pneumoniae polymerase chain reaction assay.

Results: Most subjects had MRMP (78.4%), and all mutated strains had the A2063G transition. We defined MRMP* (n = 285) as MRMP pneumonia requiring admission and MSMP* (n = 72) as MSMP pneumonia requiring admission. Patients with MRMP pneumonia were older, more likely to have segmental/lobar pneumonia, and had more febrile days than those with MSMP pneumonia. C-reactive protein (CRP), lactate dehydrogenase (LDH), and percentage neutrophils were more strongly associated with MRMP* than MSMP* groups. Percentage neutrophils, CRP, and alanine aminotransferase significantly changed between admission and follow-up measurements in patients with MRMP* (P < 0.05). The duration of admission positively correlated with the number of febrile days after initiation of antibiotic medication and laboratory variables (white blood cell count, CRP, and aspartate aminotransferase [AST]) (P < 0.05). Random forest analysis indicated that the number of febrile days after initiation of antibiotic medication, AST, and percentage neutrophils at admission was over five.

Conclusions: This study indicated that children with M. pneumoniae pneumonia with a higher number of febrile days after initiation of antibiotic medication, AST, and percentage neutrophils at admission were more likely to have prolonged admission duration.

Keywords: M. pneumoniae; aspartate aminotransferase; children; macrolide-resistant M. pneumoniae; neutrophil portion.

FIGURE 1

Study population. MRMP, macrolide‐resistant Mycoplasma pneumoniae ; MSMP, macrolide‐susceptible M. pneumoniae ; PCR, polymerase chain reaction

FIGURE 2

Factors significantly associated with prolonged length of hospitalization (P < 0.05, except tetracycline or quinolone). Red line: positive correlation; blue line: negative correlation; Rho: correlation coefficient

FIGURE 3

Random forest variable importance plot. Mean decrease accuracy measures the model's performance without each variable. A higher value indicates the importance of different variables on prolonged length of hospitalization in children with Mycoplasma pneumoniae . Removal of that variables causes the model to lose accuracy in prediction. MRMP, macrolide‐resistant M. pneumoniae