A comparison of diagnostic and therapeutic approaches for Mycoplasma pneumoniae pneumonia in children and adults, during the post-COVID-19 pandemic era

Abstract

Objectives: Post-COVID-19, the increasing incidence of adult Mycoplasma pneumoniae pneumonia (MPP) necessitates attention, as it remains understudied due to its low incidence and undefined severity criteria. Therefore, exploring the characteristics of adult MPP and child MPP in terms of clinical diagnosis, treatment, and prognosis is of significant clinical importance. This study investigated the clinical features, severe risk factors, treatment, and prognosis of MPP in children and adults in Hebei, China, following the lifting of COVID-19 lockdown measures, offering insights for the diagnosis and treatment of MPP across age groups.

Methods: From May 2023 to March 2024, a total of 218 hospitalized MPP patients at the First Hospital of Hebei Medical University were enrolled, with children (≤ 14 years) and adults (≥ 18 years) randomly selected at a 1:1 ratio (109 children and 109 adults). Patient demographics and clinical data were recorded and analyzed to compare the diagnostic and treatment profiles of pediatric and adult MPP patients.

Results: This study revealed that among 218 MPP patients, adult MPP patients differ significantly from child MPP patients in terms of clinical symptoms, the inflammatory response, coagulation status, and organ damage. In addition, C-reactive protein (CRP) (OR, 1.073; 95% CI, 1.032-1.116; P < 0.001) was a severe risk factor for adult MPP, whereas CRP, aspartate transaminase, and potassium (OR: 1.209, 1.124, 31.322; 95% CI: 1.072-1.362, 1.016-1.244, 3.112-315.213; P = 0.008, 0.02, 0.003) were positively associated with the severity of MPP in children. Interestingly, children and adults with MPP received different treatments, and adult MPP patients had shorter hospital stays but poorer lung infection resolution. The positive detection rate of macrolide-resistance genes was 70.8% (34/48). Compared with the macrolide-resistance MPP (MRMPP) subgroup in children (treated with macrolides), the MRMPP subgroup in adults (treated with quinolones) had shorter hospital stays and higher rates of improvement in lung infection (P < 0.05), and the recovery of eosinophil percentage, white blood cell count, neutrophil count and platelet-lymphocyte ratio was better.

Conclusion: In short, adult and child MPPs differ significantly in terms of clinical diagnosis, treatment, and prognosis. Early intervention for severe risk factors, monitoring MR genes and managing macrolides can lead to improved prognosis.

Keywords: Mycoplasma pneumoniae pneumonia (MPP); COVID-19; Children and adults; Clinical characteristics; Macrolide resistance; Severe risk factors; Treatment.