Abstract

MACROLIDE-RESISTANT MYCOPLASMA PNEUMONIAE IN HOSPITALIZED SCHOOL-AGED CHILDREN: PREVALENCE, CLINICAL IMPACT, AND RISK FACTORS

Edna Bubelwa, Baraka Mkuye, Luo Hong, Jialing Liu, Jiefang Ye, Kaiyuan Luo and Xingyu Rao*

Abstract

Objective: This retrospective study aimed to assess macrolide- resistant Mycoplasma pneumoniae (MRMP) prevalence in 6-12 year old hospitalized Mycoplasma pneumoniae pneumonia (MPP) patients, compare clinical characteristics and outcomes between MRMP and macrolide- susceptible M. pneumoniae (MSMP) cases, and identify MRMP associated factors. Method: Hospitalized children with MPP from July 2022 to July 2024 were recruited, with MRMP identified through specific mutations in the 23S rRNA gene. Multivariate logistic regression was employed to isolate independent risk factors for MRMP. Result: Out of 549 MPP children, 358 (65%) were positive for M. pneumoniae DNA. Among them, 272 (76%) were MRMP and 86 (24%) were MSMP. MRMP patients experienced longer fever duration and hospitalization, alongside higher rates of myocardial injury and intensive care unit (ICU) admissions. MRMP was characterized by elevated D-dimer levels, lactate dehydrogenase (LDH), serum ferritin (SF), interleukin-6 (IL- 6) and interferon-gamma (IFN-γ). Radiographically, MRMP demonstrated aggressive lung involvement, including multilobar involvement. Factors independently associated with MRMP included symptom duration ≥7 days (OR= 3.74, 95% CI 2.04-6.88), multilobar involvment (OR= 4.57, 95% CI 2.25-9.28), delayed treatment escalation to tetracyclines/fluoroquinolones (OR= 13.45, 95% CI 5.47-33.07), IFN-γ (OR= 3.49, 95% CI 1.75-6.97) and viral co-infection (OR=9.78, 95% CI 4.13-23.16) Conclusion: The study establishes MRMP as a high-risk pneumonia subtype driven by IFN-γ-mediated hyperinflammation and viral co-infection synergy. These findings align with the growing global efforts to combat antimicrobial resistance in M. pneumoniae infections and build on existing guidelines by emphasizing the importance of early resistance testing and personalized treatment strategies for pediatric patients.

Keywords: Mycoplasma pneumoniae; Macrolide resistance; Children; Prevalence; Pneumonia.