Evaluation of Clinical Features and Treatment of Mycoplasma pneumoniae in Children With Macrolide-Resistant and Macrolide-Susceptible Infection.

AIM: To compare clinical and imaging features in children with macrolide-susceptible (MSMP) and macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMP) in a real-world clinical setting.

METHODS

We retrospectively analysed paediatric M. pneumoniae (MP) cases at Hunan People's Hospital from June to December 2023, utilizing polymerase chain reaction (PCR) to categorize infections into MRMP and MSMP groups based on 23S rRNA mutations. We compared symptoms, laboratory findings, imaging results and treatment outcomes between MRMP and MSMP groups. Additionally, univariate and multivariate logistic regression analyses were performed to identify factors associated with the switch to doxycycline in MRMP patients.

RESULTS

Of 199 children with MP, 151 were categorized as MRMP due to 23S rRNA mutations, while 48 were classified as MSMP. The MRMP group included more preschool- and school-aged children, with more severe symptoms (persistent high fever and extensive lung consolidation). MRMP patients received longer antibiotic courses, with imaging showing segmental or lobar infiltrates. Consequently, treatment was switched from azithromycin to doxycycline in 66.2% of MRMP patients. Multivariate logistic regression analysis revealed that segmental or lobar parenchymal infiltration was independently associated with an increased likelihood of receiving doxycycline (OR = 3.942, p < 0.001).

CONCLUSION

These real-world data suggest that MRMP may present with more severe clinical manifestations and radiological features than MSMP among hospitalized children during an atypical post-COVID resurgence of MP. Doxycycline could be considered as the second-line therapy for MRMP patients exhibiting severe symptoms or lung consolidation when macrolides fail to achieve clinical improvement.