Clinical features of macrolide-resistant Mycoplasma pneumoniae pneumonia: Can the JRS pneumonia guidelines be applied?

BACKGROUND

The JRS pneumonia guidelines 2024 created and recommend a predictive score for clinical diagnosis of Mycoplasma pneumoniae pneumonia. However, there are no data examining its usefulness in macrolide-resistant M. pneumoniae pneumonia, so we verified the validity of the diagnostic prediction score in macrolide-resistant M. pneumoniae pneumonia.

METHODS

We compared 113 cases of macrolide-resistant M. pneumoniae pneumonia and 114 cases of macrolide-sensitive M. pneumoniae pneumonia. Gene mutation analysis of the 23S rRNA domain V of resistant strains revealed that adenine at position 2063 was replaced with guanine in all strains.

RESULTS

The Mycoplasma Pneumonia Diagnosis Prediction Score consists of six parameters, and the frequency of agreement was high at over 70% for all parameters, and no difference was observed between the resistant and sensitive groups. When 5 or more of the 6 diagnostic criteria were used as positive criteria, the sensitivity for predicting M. pneumoniae pneumonia was 71.7% in the resistant group and 67.5% in the sensitive group, with no difference between the two groups. Chest computed tomography (CT) image findings showed no difference in the characteristics of shadows between the resistant and sensitive groups, with bronchial wall thickening and centrilobular nodules frequently observed.

CONCLUSIONS

The clinical presentation of macrolide-resistant M. pneumoniae pneumonia and macrolide-sensitive M. pneumoniae pneumonia were similar, and the concordance rate of Mycoplasma Pneumonia Diagnostic Prediction Score was comparable. However, this study design was unable to evaluate important parameters of the Mycoplasma Pneumonia Diagnostic Prediction Score, and it remains unclear whether it is applicable in clinical practice.