Allergy Asthma Respir Dis.  2018 Mar;6(2):116-121. 10.4168/aard.2018.6.2.116.

Related factors for and changes in clinical manifestations in mycoplasma pneumonia nonresponsive to macrolide treatment

Affiliations
  • 1Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea. hbkim@paik.ac.kr
  • 2Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea.

Abstract

PURPOSE
Mycoplasma pneumonia is known to be a major cause of community-acquired pneumonia in children. Macrolide has been the first-line treatment for mycoplasma pneumonia, but recently there has been an increasing tendency of macrolide-resistant Mycoplasma pneumoniae (MRMP). Therefore, this study aimed to investigate the clinical tendency and the therapeutic responsibility of mycoplasma pneumonia in terms of the fever duration after treatment and its associated factors.
METHODS
A total of 346 children admitted with mycoplasma pneumonia during 3 recent periods (2008-2009, 2011-2012, and 2015-2016) were investigated with clinical manifestations, laboratory test results and chest x-ray findings. Patients were grouped according to fever duration and analyzed for differences in clinical features.
RESULTS
There was no statistically significant difference in age or sex between the 3 periods (P=0.284 and P=0.559, respectively). Total fever duration during mycoplasma pneumonia was increased with time (P for trend < 0.001). The patients with a longer fever duration (≥3 days) after macrolide treatment presented with a higher CRP (P < 0.001) and with lobar-type pneumonia (P=0.020) compared to those with a shorter fever duration. Fever duration after steroid treatment became longer in the longer fever group in 2011 (P=0.015) and 2015 (P < 0.001), but not in 2008 (P=0.536).
CONCLUSION
This study showed that the therapeutic effect of macrolide or steroid for mycoplasma pneumonia is recently attenuating and that high CRP, lobar-type pneumonia and presence of pleural effusion were the associated factors. Therefore, efforts to decrease MRMP and to develop better treatment guidelines for mycoplasma pneumonia are needed in the future.

Keyword

Mycoplasma pneumonia; Macrolide; Fever; Steroid

MeSH Terms

Child
Fever
Humans
Mycoplasma pneumoniae
Mycoplasma*
Pleural Effusion
Pneumonia
Pneumonia, Mycoplasma*
Thorax

Reference

1. Lee KY. Pediatric respiratory infections by Mycoplasma pneumoniae. Expert Rev Anti Infect Ther. 2008; 6:509–21.
2. Atkinson TP, Balish MF, Waites KB. Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infections. FEMS Microbiol Rev. 2008; 32:956–73.
3. Hong KB, Choi EH, Lee HJ, Lee SY, Cho EY, Choi JH, et al. Macrolide resistance of Mycoplasma pneumoniae, South Korea, 2000-2011. Emerg Infect Dis. 2013; 19:1281–4.
4. Shen Y, Zhang J, Hu Y, Shen K. Combination therapy with immune-modulators and moxifloxacin on fulminant macrolide-resistant Mycoplasma pneumoniae infection: a case report. Pediatr Pulmonol. 2013; 48:519–22.
Article
5. Sztrymf B, Jacobs F, Fichet J, Hamzaoui O, Prat D, Avenel A, et al. Mycoplasma-related pneumonia: a rare cause of acute respiratory distress syndrome (ARDS) and of potential antibiotic resistance. Rev Mal Respir. 2013; 30:77–80.
6. Wang RS, Wang SY, Hsieh KS, Chiou YH, Huang IF, Cheng MF, et al. Necrotizing pneumonitis caused by Mycoplasma pneumoniae in pediatric patients: report of five cases and review of literature. Pediatr Infect Dis J. 2004; 23:564–7.
7. Katsushima Y, Katsushima F, Suzuki Y, Seto J, Mizuta K, Nishimura H, et al. Characteristics of Mycoplasma pneumoniae infection identified on culture in a pediatric clinic. Pediatr Int. 2015; 57:247–52.
8. Liu Y, Ye X, Zhang H, Xu X, Li W, Zhu D, et al. Antimicrobial susceptibility of Mycoplasma pneumoniae isolates and molecular analysis of mac-rolide-resistant strains from Shanghai, China. Antimicrob Agents Chemother. 2009; 53:2160–2.
9. Xin D, Mi Z, Han X, Qin L, Li J, Wei T, et al. Molecular mechanisms of macrolide resistance in clinical isolates of Mycoplasma pneumoniae from China. Antimicrob Agents Chemother. 2009; 53:2158–9.
10. Kim JH, Kim JY, Yoo CH, Seo WH, Yoo Y, Song DJ, et al. Macrolide resistance and its impacts on M. Pneumoniae pneumonia in children: comparison of two recent epidemics in Korea. Allergy Asthma Immunol Res. 2017; 9:340–6.
Article
11. Pereyre S, Goret J, Bébéar C. Mycoplasma pneumoniae: current knowledge on macrolide resistance and treatment. Front Microbiol. 2016; 7:974.
Article
12. Principi N, Esposito S. Macrolide-resistant Mycoplasma pneumoniae: its role in respiratory infection. J Antimicrob Chemother. 2013; 68:506–11.
Article
13. Yoo SJ, Kim HB, Choi SH, Lee SO, Kim SH, Hong SB, et al. Differences in the frequency of 23S rRNA gene mutations in Mycoplasma pneumoniae between children and adults with community-acquired pneumonia: clinical impact of mutations conferring macrolide resistance. Antimicrob Agents Chemother. 2012; 56:6393–6.
Article
14. Nagayama Y, Sakurai N, Yamamoto K, Honda A, Makuta M, Suzuki R. Isolation of Mycoplasma pneumoniae from children with lower-respiratory-tract infections. J Infect Dis. 1988; 157:911–7.
Article
15. Kawai Y, Miyashita N, Yamaguchi T, Saitoh A, Kondoh E, Fujimoto H, et al. Clinical efficacy of macrolide antibiotics against genetically determined macrolide-resistant Mycoplasma pneumoniae pneumonia in paediatric patients. Respirology. 2012; 17:354–62.
Article
16. Miyashita N, Kawai Y, Inamura N, Tanaka T, Akaike H, Teranishi H, et al. Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults. J Infect Chemother. 2015; 21:153–60.
Article
17. Luo Z, Luo J, Liu E, Xu X, Liu Y, Zeng F, et al. Effects of prednisolone on refractory mycoplasma pneumoniae pneumonia in children. Pediatr Pulmonol. 2014; 49:377–80.
Article
18. Lu A, Wang C, Zhang X, Wang L, Qian L. Lactate dehydrogenase as a biomarker for prediction of refractory Mycoplasma pneumoniae pneumonia in children. Respir Care. 2015; 60:1469–75.
Article
19. Inamura N, Miyashita N, Hasegawa S, Kato A, Fukuda Y, Saitoh A, et al. Management of refractory Mycoplasma pneumoniae pneumonia: utility of measuring serum lactate dehydrogenase level. J Infect Chemother. 2014; 20:270–3.
Article
20. Zhang Y, Chen Y, Chen Z, Zhou Y, Sheng Y, Xu D, et al. Effects of bron-choalveolar lavage on refractory Mycoplasma pneumoniae pneumonia. Respir Care. 2014; 59:1433–9.
Article
Full Text Links
  • AARD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr