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

• Published in: Journal of clinical medicine 2022-01, Vol.11 (2), p.306
• Main Authors: Choi, Yun Jung, Chung, Eun Hee, Lee, Eun, Kim, Chul-Hong, Lee, Yong Ju, Kim, Hyo-Bin, Kim, Bong-Seong, Kim, Hyung Young, Cho, Yoojung, Seo, Ju-Hee, Sol, In Suk, Sung, Myongsoon, Song, Dae Jin, Ahn, Young Min, Oh, Hea Lin, Yu, Jinho, Jung, Sungsu, Lee, Kyung Suk, Lee, Ju Suk, Jang, Gwang Cheon, Jang, Yoon-Young, Chung, Hai Lee, Choi, Sung-Min, Han, Man Yong, Shim, Jung Yeon, Kim, Jin Tack, Kim, Chang-Keun, Yang, Hyeon-Jong, Suh, Dong In
• Format: Article
• Language: English
• Subjects: Age; Antibiotics; Clinical medicine; Fever; Hospitalization; Hospitals; Laboratories; Mutation; Normal distribution; Patients; Pediatrics; Pneumonia; Respiratory diseases
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm11020306

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 . Early discrimination of macrolide-refractory pneumonia (MrMP) from macrolide-sensitive 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 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 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% ( = 725/4159) of patients, with asthma being the most common ( = 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.