Korean J Pediatr.  2014 Jun;57(6):271-277. 10.3345/kjp.2014.57.6.271.

Increased risk of refractory Mycoplasma pneumoniae pneumonia in children with atopic sensitization and asthma

Affiliations
  • 1Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jy7.shim@samsung.com

Abstract

PURPOSE
A nationwide outbreak of Mycoplasma pneumoniae pneumonia (MP) refractory to macrolide antibiotics occurred in Korea during 2011. Steroid therapy has been reported to be both efficacious and well tolerated in pediatric patients with refractory MP. We compared clinical features and laboratory characteristics between children with refractory MP requiring steroid treatment and those with macrolide-responsive MP and evaluated the risk factors associated with refractory MP.
METHODS
We investigated 203 children who were admitted to our institution with MP from June to November 2011. Refractory MP was defined by persistent fever over 38.3degrees C with progressive pulmonary consolidation or pleural effusion despite administration of appropriate macrolide antibiotics for 5 days or longer after admission. Steroid therapy was initiated on the fifth day after admission for refractory cases.
RESULTS
There were 26 patients with refractory MP requiring steroid therapy. The mean duration of steroid therapy was 5.4 days and most of the patients were afebrile within 24 hours after initiation of steroid therapy. The prevalence of refractory MP was higher in patients with pleural effusion, lobar pneumonia affecting more than 2 lobes, higher levels of serum lactate dehydrogenase, increased oxygen requirements, and longer duration of hospitalization. Atopic sensitization and history of asthma were also associated with refractory MP after adjusting for age and gender.
CONCLUSION
Children with refractory MP had more severe pneumonia. Atopic sensitization and history of asthma may be risk factors for refractory MP requiring steroid therapy in Korean children.

Keyword

Asthma; Atopy; Child; Pneumonia; Mycoplasma

MeSH Terms

Anti-Bacterial Agents
Asthma*
Child*
Fever
Hospitalization
Humans
Korea
L-Lactate Dehydrogenase
Mycoplasma
Mycoplasma pneumoniae*
Oxygen
Pleural Effusion
Pneumonia*
Pneumonia, Mycoplasma*
Prevalence
Risk Factors
Anti-Bacterial Agents
L-Lactate Dehydrogenase
Oxygen
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