Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study

被引：47

作者：

Choi, Yun Jung ^{[1
,2
]}

Chung, Eun Hee ^{[3
]}

Lee, Eun ^{[4
]}

Kim, Chul-Hong ^{[5
]}

Lee, Yong Ju ^{[6
]}

Kim, Hyo-Bin ^{[7
]}

Kim, Bong-Seong ^{[8
]}

Kim, Hyung Young ^{[9
]}

Cho, Yoojung ^{[10
]}

Seo, Ju-Hee ^{[11
]}

Sol, In Suk ^{[12
]}

Sung, Myongsoon ^{[13
]}

Song, Dae Jin ^{[14
]}

Ahn, Young Min ^{[15
]}

Oh, Hea Lin ^{[16
]}

Yu, Jinho ^{[17
]}

Jung, Sungsu ^{[9
]}

Lee, Kyung Suk ^{[18
]}

Lee, Ju Suk ^{[5
]}

Jang, Gwang Cheon ^{[19
]}

Jang, Yoon-Young ^{[20
]}

Chung, Hai Lee ^{[20
]}

Choi, Sung-Min ^{[21
]}

Han, Man Yong ^{[22
]}

Shim, Jung Yeon ^{[12
]}

Kim, Jin Tack ^{[23
]}

Kim, Chang-Keun ^{[7
]}

Yang, Hyeon-Jong ^{[10
,24
]}

Suh, Dong In ^{[2
]}

机构：

[1] Seoul Natl Univ Hosp, Hosp Med Ctr, Seoul KS013, South Korea

[2] Seoul Natl Univ Hosp, Dept Pediat, Seoul KS013, South Korea

[3] Chungnam Natl Univ, Chungnam Natl Univ Hosp, Sch Med, Dept Pediat, Daejeon KS015, South Korea

[4] Chonnam Natl Univ, Chonnam Natl Univ Hosp, Med Sch, Dept Pediat, Gwangju KS018, South Korea

[5] Sungkyunkwan Univ, Samsung Changwon Hosp, Sch Med, Dept Pediat, Chang Won KS011, South Korea

[6] Yongin Severance Hosp, Dept Pediat, Yongin KS009, South Korea

[7] Inje Univ, Sanggye Paik Hosp, Dept Pediat, Asthma & Allergy Ctr, Seoul KS013, South Korea

[8] Univ Ulsan, Gangneung Asan Hosp, Dept Pediat, Kangnung KS007, South Korea

[9] Pusan Natl Univ, Childrens Hosp, Dept Pediat, Yangsan KS011, South Korea

[10] Soonchunhyang Univ, Seoul Hosp, SCH Biomed Informat Res Unit, Seoul KS013, South Korea

[11] Dankook Univ, Dankook Univ Hosp, Med Sch, Dept Pediat, Cheonan KS002, South Korea

[12] Sungkyunkwan Univ, Kangbuk Samsung Hosp, Sch Med, Dept Pediat, Seoul KS013, South Korea

[13] Soonchunhyang Univ, Gumi Hosp, Dept Pediat, Gumi KS010, South Korea

[14] Korea Univ, Guro Hosp, Coll Med, Dept Pediat, Seoul KS013, South Korea

[15] Eulju Univ, Eulji Gen Hosp, Dept Pediat, Seoul KS013, South Korea

[16] Korea Canc Ctr Hosp, Dept Pediat, Seoul KS013, South Korea

[17] Univ Ulsan, Asan Med Ctr, Coll Med, Dept Pediat, Seoul KS013, South Korea

[18] Hanyang Univ, Guri Hosp, Coll Med, Dept Pediat, Guri KS013, South Korea

[19] Ilsan Hosp, Natl Hlth Insurance Serv, Dept Pediat, Goyang KS007, South Korea

[20] Catholic Univ Korea, Sch Med, Dept Pediat, Daegu KS002, South Korea

[21] Dongguk Univ, Gyeongju Hosp, Dept Pediat, Gyeongju KS010, South Korea

[22] CHA Univ, CHA Bundang Med Ctr, Sch Med, Dept Pediat, Seongnam KS009, South Korea

[23] Catholic Univ Korea, Coll Med, Dept Pediat, Seoul KS013, South Korea

[24] Soonchunhyang Univ, Seoul Hosp, Coll Med, Dept Pediat, Seoul KS013, South Korea

来源：

JOURNAL OF CLINICAL MEDICINE | 2022年 / 11卷 / 02期

关键词：

Mycoplasma pneumoniae pneumonia; macrolide refractory Mycoplasma pneumoniae pneumonia; children; LACTATE-DEHYDROGENASE; INFECTION; AZITHROMYCIN; PREDICTION; MANAGEMENT; BIOMARKER; ASTHMA;

D O I：

10.3390/jcm11020306

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides.

引用

页数：15

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