Prevalence of Macrolide-resistant Mycoplasma pneumoniae in Children and Adolescents with Community-acquired Pneumonia: A Prospective Study in Thailand

Abstract

Background: – We describe the prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP)-induced pediatric community-acquired pneumonia (CAP) in Bangkok, Thailand. Methods: – Nasopharyngeal aspirates were prospectively collected from children and adolescents 0–18 years of age with chest radiograph-confirmed CAP between January 2014 and January 2020 at a single tertiary-care center in Bangkok, Thailand. M. pneumoniae was identified from nasopharyngeal aspirates using real-time polymerase chain reaction (RT-PCR). Macrolide-resistant mutations, including A2063G, A2064G, A2067G and C2617G in the 23S rRNA gene, were identified through PCR-sequencing. Results: – Of 332 patients with CAP, 55 (16.6%) had M. pneumoniae infection. Among those with mycoplasmal pneumonia, the median age (range) was 8.3 years (1.2–17.5), and 30 (54.5%) were female. Twenty-five patients (45.5%) developed complications, including 12 (21.8%) cases of pleural effusion, 10 (18.1%) cases of skin rashes, 6 (10.9%) cases of hematologic complications, 2 (3.6%) cases of transaminitis, and 1 (1.8%) case of respiratory failure. Of the 36 patients who underwent genotyping, 8 (22.2%) carried macrolide-resistant mutations—all A2063G mutations. Compared with those without macrolide-resistant mutations, patients with MRMP had a longer time to defervescence after antimicrobial therapy (3.0 vs. 5.5 days, P = 0.003). Patients with and without macrolide-resistant mutations had similar rates of previous exposure to macrolide antibiotics, durations of fever and cough, rates of complications, frequency of oxygen supplementation requirements, lengths of hospitalization and macrolide treatment failure. Conclusions: – About 1 in 5 children and adolescents with mycoplasmal CAP in Thailand have infections caused by MRMP, which result in a longer time to defervescence after therapy. Monitoring MRMP is crucial to establish local treatment strategies for pediatric CAP.