Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Prevalence and clinical manifestations of macrolide resistant Mycoplasma pneumoniae pneumonia in Korean children

  • Lee, Eun (Department of Pediatrics, Chonnam National University Hospital) ;
  • Cho, Hyun-Ju (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Soo-Jong (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jina (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sung, Heungsup (Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yu, Jinho (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2016.09.08
  • Accepted : 2016.12.21
  • Published : 2017.05.15
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Abstract

Purpose: Macrolide resistance rate of Mycoplasma pneumoniae has rapidly increased in children. Studies on the clinical features between macrolide susceptible-M. pneumoniae (MSMP) and macrolide resistant-M. pneumoniae (MRMP) are lacking. The aim of this study was to identify the macrolide resistance rate of M. pneumoniae in Korean children with M. pneumoniae penupmonia in 2015 and compare manifestations between MSMP and MRMP. Methods: Among 122 children (0-18 years old) diagnosed with M. pneumoniae pneumonia, 95 children with the results of macrolide sensitivity test were included in this study. Clinical manifestations were acquired using retrospective medical records. Results: The macrolide resistant rate of M. pneumoniae was 87.2% (82 of 94 patients) in children with M. pneumoniae pneumonia. One patient showed a mixed type of wild type and A2063G mutation in 23S rRNA of M. pneumoniae. There were no significant differences in clinical, laboratory, and radiologic findings between the MSMP and MRMP groups at the first visit to our hospital. The time interval between initiation of macrolide and defervescence was significantly longer in the MRMP group ($4.9{\pm}3.3$ vs. $2.8{\pm}3.1days$, P=0.039). Conclusion: The macrolide resistant rate of M. pneumoniae is very high in children with M. pneumoniae pneumonia in Korea. The clinical manifestations of MRMP are similar to MSMP except for the defervescence period after administration of macrolide. Continuous monitoring of the occurrence and antimicrobial susceptibility of MRMP is required to control its spread and establish strategies for treating second-line antibiotic resistant M. pneumoniae infection.

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References

  1. Eun BW, Kim NH, Choi EH, Lee HJ. Mycoplasma pneumoniae in Korean children: the epidemiology of pneumonia over an 18-year period. J Infect 2008;56:326-31. https://doi.org/10.1016/j.jinf.2008.02.018
  2. Defilippi A, Silvestri M, Tacchella A, Giacchino R, Melioli G, Di Marco E, et al. Epidemiology and clinical features of Mycoplasma pneumoniae infection in children. Respir Med 2008;102:1762-8. https://doi.org/10.1016/j.rmed.2008.06.022
  3. Kwiatkowska B, Maslinska M. Macrolide therapy in chronic inflammatory diseases. Mediators Inflamm 2012;2012:636157.
  4. Lucier TS, Heitzman K, Liu SK, Hu PC. Transition mutations in the 23S rRNA of erythromycin-resistant isolates of Mycoplasma pneumoniae. Antimicrob Agents Chemother 1995;39:2770-3. https://doi.org/10.1128/AAC.39.12.2770
  5. 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. https://doi.org/10.3201/eid1908.121455
  6. Dumke R, von Baum H, Luck PC, Jacobs E. Occurrence of macrolide-resistant Mycoplasma pneumoniae strains in Germany. Clin Microbiol Infect 2010;16:613-6. https://doi.org/10.1111/j.1469-0691.2009.02968.x
  7. Cao B, Zhao CJ, Yin YD, Zhao F, Song SF, Bai L, et al. High prevalence of macrolide resistance in Mycoplasma pneumoniae isolates from adult and adolescent patients with respiratory tract infection in China. Clin Infect Dis 2010;51:189-94. https://doi.org/10.1086/653535
  8. Okada T, Morozumi M, Tajima T, Hasegawa M, Sakata H, Ohnari S, et al. Rapid effectiveness of minocycline or doxycycline against macrolide-resistant Mycoplasma pneumoniae infection in a 2011 outbreak among Japanese children. Clin Infect Dis 2012;55:1642-9. https://doi.org/10.1093/cid/cis784
  9. Principi N, Esposito S. Macrolide-resistant Mycoplasma pneumoniae: its role in respiratory infection. J Antimicrob Chemother 2013;68:506-11. https://doi.org/10.1093/jac/dks457
  10. Miyashita N, Kawai Y, Akaike H, Ouchi K, Hayashi T, Kurihara T, et al. Macrolide-resistant Mycoplasma pneumoniae in adolescents with community-acquired pneumonia. BMC Infect Dis 2012;12: 126. https://doi.org/10.1186/1471-2334-12-126
  11. Suzuki S, Yamazaki T, Narita M, Okazaki N, Suzuki I, Andoh T, et al. Clinical evaluation of macrolide-resistant Mycoplasma pneumoniae. Antimicrob Agents Chemother 2006;50:709-12. https://doi.org/10.1128/AAC.50.2.709-712.2006
  12. Matsubara K, Morozumi M, Okada T, Matsushima T, Komiyama O, Shoji M, et al. A comparative clinical study of macrolide-sensitive and macrolide-resistant Mycoplasma pneumoniae infections in pediatric patients. J Infect Chemother 2009;15:380-3. https://doi.org/10.1007/s10156-009-0715-7
  13. Liu Y, Ye X, Zhang H, Xu X, Li W, Zhu D, et al. Characterization of macrolide resistance in Mycoplasma pneumoniae isolated from children in Shanghai, China. Diagn Microbiol Infect Dis 2010;67: 355-8. https://doi.org/10.1016/j.diagmicrobio.2010.03.004
  14. McIntosh K. Community-acquired pneumonia in children. N Engl J Med 2002;346:429-37. https://doi.org/10.1056/NEJMra011994
  15. 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. https://doi.org/10.1128/AAC.01421-12
  16. Wolff BJ, Thacker WL, Schwartz SB, Winchell JM. Detection of macrolide resistance in Mycoplasma pneumoniae by real-time PCR and high-resolution melt analysis. Antimicrob Agents Chemother 2008;52:3542-9. https://doi.org/10.1128/AAC.00582-08
  17. Oh CE, Choi EH, Lee HJ. Detection of genetic mutations associated with macrolide resistance of Mycoplasma pneumoniae. Korean J Pediatr 2010;53:178-83. https://doi.org/10.3345/kjp.2010.53.2.178
  18. Korea Centers for Disease Control and Prevention. Acute infectious agents laboratory surveillance reports [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; c2012 [cited 2014 Oct 2]. Available from: http://www.cdc.go.kr.
  19. Chironna M, Sallustio A, Esposito S, Perulli M, Chinellato I, Di Bari C, et al. Emergence of macrolide-resistant strains during an outbreak of Mycoplasma pneumoniae infections in children. J Antimicrob Chemother 2011;66:734-7. https://doi.org/10.1093/jac/dkr003
  20. Pereyre S, Charron A, Renaudin H, Bebear C, Bebear CM. First report of macrolide-resistant strains and description of a novel nucleotide sequence variation in the P1 adhesin gene in Mycoplasma pneumoniae clinical strains isolated in France over 12 years. J Clin Microbiol 2007;45:3534-9. https://doi.org/10.1128/JCM.01345-07
  21. Morozumi M, Takahashi T, Ubukata K. Macrolide-resistant Mycoplasma pneumoniae: characteristics of isolates and clinical aspects of community-acquired pneumonia. J Infect Chemother 2010;16: 78-86. https://doi.org/10.1007/s10156-009-0021-4
  22. Yang J, Hooper WC, Phillips DJ, Talkington DF. Cytokines in Mycoplasma pneumoniae infections. Cytokine Growth Factor Rev 2004;15:157-68. https://doi.org/10.1016/j.cytogfr.2004.01.001
  23. Ye Y, Li S, Yajun L, Li Y, Ren T, Liu K. Mycoplasma pneumoniae 23S rRNA gene mutations and mechanisms of macrolide resistance. Lab Med 2013;44:63-8. https://doi.org/10.1309/LMYEY7P26RHWRRUL
  24. Cardinale F, Chironna M, Dumke R, Binetti A, Daleno C, Sallustio A, et al. Macrolide-resistant Mycoplasma pneumoniae in paediatric pneumonia. Eur Respir J 2011;37:1522-4. https://doi.org/10.1183/09031936.00172510
  25. Sun H, Chen Z, Yan Y, Huang L, Wang M, Ji W. Epidemiology and clinical profiles of Mycoplasma pneumoniae infection in hospitalized infants younger than one year. Respir Med 2015;109:751-7. https://doi.org/10.1016/j.rmed.2015.04.006

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