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Review
. 2025 Mar;54(3):530-541.
doi: 10.18502/ijph.v54i3.18246.

Recent Macrolide Resistance Pattern of Mycoplasma Pneumonia in the World: A Systematic Review and Meta-Analysis

Ilad Alavi Darazam  1   2   3 , Mohammad Mahdi Rabiei  1   2 , Farid Javandoust Gharehbagh  1   2 , Firouze Hatami  1   2 , Shahrzad Shahrokhi  1 , Ali Akhgarzad  4 , Hadi Allahverdi Nazhand  4 , Hadi Ebadi  4 , Amir Hossein Zeininasab  4 , Neda Kazeminia  5   6 , Legha Lotfollahi  7 , Sajad Shojaee  8
Affiliations
Review

Recent Macrolide Resistance Pattern of Mycoplasma Pneumonia in the World: A Systematic Review and Meta-Analysis

Ilad Alavi Darazam et al. Iran J Public Health. 2025 Mar.

Abstract

Background: We aimed to systematically review and analyze the prevalence and pattern of resistance in Mycoplasma pneumoniae.

Methods: We searched authentic scientific sources and databases, and reference lists of relevant articles from Jan 1, 2017, to Jun 1, 2023.

Results: Most of the included studies were conducted in Asia (11470 patients). The overall pooled prevalence was 53% (41%-65%), I2=99.69%; P <0.001. While subgroups analyses revealed that the pooled prevalence for America (3 studies), Asia (29 studies), and Europe (3 studies) was 9% (5%-12%), 62% (52%-73%), and 6% (1%-12%), respectively. Twenty-one eligible studies for determining of A2063G and 16 for A2064G were analyzed. Global pooled prevalence was 67% (58%-76%), I2=99.65%; P<0.001, and 3% (2%-4%), I2=87.44%; P<0.001 for A2063G and A2064G, respectively. Pooled prevalence of A2063G for America, Asia and Europe was 10% (5%-16%), 77% (71%-83%) and 5% (2%-9%), respectively.

Conclusion: While the prevalence of macrolide-resistant M. pneumonia is quite low in America, it is a great dilemma in East Asia and the low prevalence in most countries could be underestimated. This study revealed an increasing trend in macrolide resistance. Indiscriminate and improper use of macrolides may be a warning in this regard.

Keywords: Antimicrobial resistance; Drug resistance; Macrolide-resistant; Meta-analysis; Mycoplasma pneumoniae.

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Figures

Fig. 1:
Fig. 1:
Flow chart of study selection for inclusion in the systematic review and meta-analysis.
Fig. 2:
Fig. 2:
Forest plot for pooled prevalence of macrolide resistance among regions of America, Asia and Europe
Fig. 3:
Fig. 3:
Forest plot for pooled prevalence of A2063G among regions of America, Asia and Europe Sixteen eligible studies for determining of A2064G were analyzed. Overall pooled prevalence was 3 % (2%–4%), I2=87.44%; P <0.001
Fig. 4:
Fig. 4:
Forest plot for pooled prevalence of A2064G among regions of America, Asia and Europe
See this image and copyright information in PMC

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