Macrolide Resistance, Clinical Features, and Cytokine Profiles in Taiwanese Children With Mycoplasma pneumoniae Infection

Tsung-Hua Wu; Nancy M Wang; Fang-Ching Liu; Hui-Hsien Pan; Fang-Liang Huang; Yu-Ping Fang; Ting-Wei Chiang; Yu-Ying Yang; Chiah-Sing Song; Hsiang-Chin Wu; Chun-Yi Lee

doi:10.1093/ofid/ofab416

Macrolide Resistance, Clinical Features, and Cytokine Profiles in Taiwanese Children With Mycoplasma pneumoniae Infection

Open Forum Infect Dis. 2021 Aug 9;8(9):ofab416. doi: 10.1093/ofid/ofab416. eCollection 2021 Sep.

Authors

Affiliations

¹ Department of Pediatrics, Show Chwan Memorial Hospital, Changhua, Taiwan.
² Department of Biology, National Changhua University of Education, Changhua, Taiwan.
³ Department of Pediatrics, Jen-Ai Hospital, Taichung, Taiwan.
⁴ Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁵ Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
⁶ Department of Pediatrics, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan.
⁷ Department of Clinical Laboratory, Show Chwan Memorial Hospital, Changhua, Taiwan.
⁸ Department of Clinical Laboratory, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan.
⁹ Department of Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan.

Abstract

Background: The factors that predict the progression of Mycoplasma pneumoniae infection remain inconclusive. Therefore, we investigated macrolide resistance prevalence, M pneumoniae genotype, and clinical characteristics of childhood M pneumoniae respiratory tract infections in Taiwan.

Methods: A total of 295 children hospitalized with respiratory tract infections with positive serological M pneumoniae immunoglobulin M test results were enrolled in this 3-year prospective study. Oropharyngeal swabs were obtained for M pneumoniae cultures and polymerase chain reaction tests. All M pneumoniae specimens were further characterized by P1 typing, multilocus variable-number tandem-repeat analysis (MLVA), and macrolide resistance genotyping. The clinical characteristics and blood cytokine profiles were analyzed accordingly.

Results: Of 138 M pneumoniae specimens, type I P1 was the predominant (136 of 138, 98.6%). The MLVA type P (4-4-5-7-2) was the leading strain (42 of 138, 30.4%), followed by type J, U, A, and X. The overall macrolide-resistant rate was 38.4% (53 of 138); the resistance rate increased dramatically yearly: 10.6% in 2017, 47.5% in 2018, and 62.5% in 2019 (P < .001). All macrolide-resistant M pneumoniae (MRMP) harbored the A2063G mutation and were MLVA type 4-5-7-2 (49 of 53, 92.5%), especially type U and X. No significant differences in clinical symptoms, duration of hospital stay, and radiographic findings were identified among patients between MRMP and macrolide-sensitive M pneumoniae (MSMP) groups. Patients with MRMP infection had more febrile days before and during hospitalization and higher interleukin (IL)-13 and IL-33 levels than patients with MSMP infection (P < .05).

Conclusions: Macrolide-resistant M pneumoniae surged in Taiwan throughout the study period, but macrolide resistance was not a determinant factor of clinical severity.

Keywords: MLVA; Mycoplasma pneumonia; children; cytokine; macrolide resistance.