Analysis of Clinical Characteristics and Risk Factors of Pediatric Macrolide-Resistant Mycoplasma pneumoniae Pneumonia from 2023 to 2025: A Single-Center Retrospective Study.

INTRODUCTION

Since 2023, re-emerging Mycoplasma pneumoniae (MP) with high macrolide resistance has challenged pediatric care.

METHODS

We retrospectively analyzed 310 children hospitalized with MP pneumonia (MPP) from 2023 to 2025.

RESULTS

Compared with macrolide-susceptible MPP (MSMPP) patients, those with macrolide-resistant MPP (MRMPP) had significantly shorter fever duration (median 5 vs 7 days) and hospital stay (median 9 vs 11 days), but more frequently received alternative antibiotics and glucocorticoids. The macrolide resistance gene positivity rate peaked at 97.3% in 2024. MRMPP patients showed elevated white blood cell counts, more pulmonary consolidation, and higher rates of tracheal occlusion. However, resistance genes were not significantly linked to severe MPP. Independent risk factors for MRMPP included albumin, pulmonary consolidation, and tracheal occlusion.

DISCUSSION: The role of resistant MP in severe disease remains controversial, clinicians should not interpret resistance mutations in isolation but tailor therapy based on clinical and radiological findings to prevent progression.