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Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study

Authors :
Yun Jung Choi
Eun Hee Chung
Eun Lee
Chul-Hong Kim
Yong Ju Lee
Hyo-Bin Kim
Bong-Seong Kim
Hyung Young Kim
Yoojung Cho
Ju-Hee Seo
In Suk Sol
Myongsoon Sung
Dae Jin Song
Young Min Ahn
Hea Lin Oh
Jinho Yu
Sungsu Jung
Kyung Suk Lee
Ju Suk Lee
Gwang Cheon Jang
Yoon-Young Jang
Hai Lee Chung
Sung-Min Choi
Man Yong Han
Jung Yeon Shim
Jin Tack Kim
Chang-Keun Kim
Hyeon-Jong Yang
Dong In Suh
Source :
Journal of Clinical Medicine, Vol 11, Iss 306, p 306 (2022), Journal of Clinical Medicine; Volume 11; Issue 2; Pages: 306, Journal of Clinical Medicine
Publication Year :
2022
Publisher :
MDPI AG, 2022.

Abstract

Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides.

Details

ISSN :
20770383
Volume :
11
Database :
OpenAIRE
Journal :
Journal of Clinical Medicine
Accession number :
edsair.doi.dedup.....02c8af2b8f0b0616640daedf26cc708b