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Case Reports
. 2023 Jul 13:16:4593-4597.
doi: 10.2147/IDR.S419873. eCollection 2023.

Clinical Value of Metagenomics Next-Generation Sequencing in Antibiotic Resistance of a Patient with Severe Refractory Mycoplasma pneumoniae Pneumonia: A Case Report

Lianjun Lin #  1 , Ruixue Zhang #  1 , Zhi Zhang  2   3 , Yujun Chang  2   3 , Rongnan Lin  2   3 , Haiwei Dou  4 , He Wang  5 , Yuchuan Wang  6 , Bo Zheng  7
Affiliations
Case Reports

Clinical Value of Metagenomics Next-Generation Sequencing in Antibiotic Resistance of a Patient with Severe Refractory Mycoplasma pneumoniae Pneumonia: A Case Report

Lianjun Lin et al. Infect Drug Resist. .

Abstract

Background: Mycoplasma pneumoniae is an important infectious pathogen of lower respiratory tract infection in children and adolescents. Macrolide resistant M. pneumoniae (MRMP) has become increasingly prevalent, and identifying pathogen resistance genes is crucial for treatment.

Case presentation: We report a patient with severe refractory M. pneumoniae pneumonia (MPP). The failure of initial clinical treatment prompted the re-analysis of metagenomic next-generation sequencing (mNGS) data for macrolide-resistant gene. Macrolide-resistance 23S ribosomal RNA gene was confirmed with read depth of 64 X for the A2063G mutation, which can decrease the affinity of macrolide with M. pneumoniae ribosome resulting in macrolide resistance. Furthermore, antimicrobial susceptibility testing demonstrated that M. pneumoniae was resistant to macrolide. PCR confirmatory test about M. pneumoniae resistance A2063G mutation, clinical treatment course and prognosis with altered treatment strategy, and M. pneumoniae antimicrobial susceptibility confirmed that the severe refractory MPP was due to macrolide resistant M. pneumoniae.

Conclusion: As a new molecular level detection, mNGS is an effective method for detecting M. pneumoniae resistance genes. Early recognition of macrolide resistance and suitable antibiotics strategy is of vital importance for the prognosis of severe refractory MPP.

Keywords: A2063G mutation; Mycoplasma pneumoniae; macrolide-resistant gene; metagenomic next-generation sequencing; pneumonia.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Timeline of the clinical course of the case and identification of A2063G mutation.
Figure 2
Figure 2
The A2063G gene mutation in the result of mNGS.
See this image and copyright information in PMC

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