Allergy, Asthma & Respiratory Disease

The Korean Academy of Asthma, Allergy and Clinical Immunology (대한천식알레르기학회)
권호 표지
DOI QR코드

DOI QR Code

Related factors for and changes in clinical manifestations in mycoplasma pneumonia nonresponsive to macrolide treatment

증가하는 마크로라이드에 반응하지 않는 마이코플라스마 폐렴의 관련 인자와 임상 양상의 변화

  • Tang, Chih-Lung (Department of Pediatrics, Inje University Sanggye Paik Hospital) ;
  • Ryu, In Kyung (Department of Pediatrics, Inje University Sanggye Paik Hospital) ;
  • Jung, Ji-Hyun (Department of Pediatrics, Inje University Sanggye Paik Hospital) ;
  • Park, Jin-Sung (Department of Pediatrics, Kangwon National University Hospital) ;
  • Kim, Hyo-Bin (Department of Pediatrics, Inje University Sanggye Paik Hospital)
  • 탕지륭 (인제대학교 상계백병원 소아청소년과) ;
  • 유인경 (인제대학교 상계백병원 소아청소년과) ;
  • 정지현 (인제대학교 상계백병원 소아청소년과) ;
  • 박진성 (강원대학교병원 소아청소년과) ;
  • 김효빈 (인제대학교 상계백병원 소아청소년과)
  • Received : 2017.07.16
  • Accepted : 2017.09.04
  • Published : 2018.03.31
⟨ Previous Next ⟩

Abstract

Purpose: Mycoplasma pneumonia is known to be a major cause of community-acquired pneumonia in children. Macrolide has been the first-line treatment for mycoplasma pneumonia, but recently there has been an increasing tendency of macrolide-resistant Mycoplasma pneumoniae (MRMP). Therefore, this study aimed to investigate the clinical tendency and the therapeutic responsibility of mycoplasma pneumonia in terms of the fever duration after treatment and its associated factors. Methods: A total of 346 children admitted with mycoplasma pneumonia during 3 recent periods (2008-2009, 2011-2012, and 2015-2016) were investigated with clinical manifestations, laboratory test results and chest x-ray findings. Patients were grouped according to fever duration and analyzed for differences in clinical features. Results: There was no statistically significant difference in age or sex between the 3 periods (P= 0.284 and P= 0.559, respectively). Total fever duration during mycoplasma pneumonia was increased with time (P for trend < 0.001). The patients with a longer fever duration (${\geq}3days$) after macrolide treatment presented with a higher CRP (P< 0.001) and with lobar-type pneumonia (P= 0.020) compared to those with a shorter fever duration. Fever duration after steroid treatment became longer in the longer fever group in 2011 (P= 0.015) and 2015 (P< 0.001), but not in 2008 (P= 0.536). Conclusion: This study showed that the therapeutic effect of macrolide or steroid for mycoplasma pneumonia is recently attenuating and that high CRP, lobar-type pneumonia and presence of pleural effusion were the associated factors. Therefore, efforts to decrease MRMP and to develop better treatment guidelines for mycoplasma pneumonia are needed in the future.

Keywords

Acknowledgement

Supported by : Inje University

References

  1. Lee KY. Pediatric respiratory infections by Mycoplasma pneumoniae. Expert Rev Anti Infect Ther 2008;6:509-21. https://doi.org/10.1586/14787210.6.4.509
  2. Atkinson TP, Balish MF, Waites KB. Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infections. FEMS Microbiol Rev 2008;32:956-73. https://doi.org/10.1111/j.1574-6976.2008.00129.x
  3. 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
  4. Shen Y, Zhang J, Hu Y, Shen K. Combination therapy with immune-modulators and moxifloxacin on fulminant macrolide-resistant Mycoplasma pneumoniae infection: a case report. Pediatr Pulmonol 2013;48: 519-22. https://doi.org/10.1002/ppul.22650
  5. Sztrymf B, Jacobs F, Fichet J, Hamzaoui O, Prat D, Avenel A, et al. Mycoplasma-related pneumonia: a rare cause of acute respiratory distress syndrome (ARDS) and of potential antibiotic resistance. Rev Mal Respir 2013;30:77-80. https://doi.org/10.1016/j.rmr.2012.06.012
  6. Wang RS, Wang SY, Hsieh KS, Chiou YH, Huang IF, Cheng MF, et al. Necrotizing pneumonitis caused by Mycoplasma pneumoniae in pediatric patients: report of five cases and review of literature. Pediatr Infect Dis J 2004;23:564-7. https://doi.org/10.1097/01.inf.0000130074.56368.4b
  7. Katsushima Y, Katsushima F, Suzuki Y, Seto J, Mizuta K, Nishimura H, et al. Characteristics of Mycoplasma pneumoniae infection identified on culture in a pediatric clinic. Pediatr Int 2015;57:247-52. https://doi.org/10.1111/ped.12513
  8. Liu Y, Ye X, Zhang H, Xu X, Li W, Zhu D, et al. Antimicrobial susceptibility of Mycoplasma pneumoniae isolates and molecular analysis of macrolide-resistant strains from Shanghai, China. Antimicrob Agents Chemother 2009;53:2160-2. https://doi.org/10.1128/AAC.01684-08
  9. Xin D, Mi Z, Han X, Qin L, Li J, Wei T, et al. Molecular mechanisms of macrolide resistance in clinical isolates of Mycoplasma pneumoniae from China. Antimicrob Agents Chemother 2009;53:2158-9. https://doi.org/10.1128/AAC.01563-08
  10. Kim JH, Kim JY, Yoo CH, Seo WH, Yoo Y, Song DJ, et al. Macrolide resistance and its impacts on M. Pneumoniae pneumonia in children: comparison of two recent epidemics in Korea. Allergy Asthma Immunol Res 2017;9:340-6. https://doi.org/10.4168/aair.2017.9.4.340
  11. Pereyre S, Goret J, Bebear C. Mycoplasma pneumoniae: current knowledge on macrolide resistance and treatment. Front Microbiol 2016;7:974.
  12. 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
  13. 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
  14. Nagayama Y, Sakurai N, Yamamoto K, Honda A, Makuta M, Suzuki R. Isolation of Mycoplasma pneumoniae from children with lower-respiratory-tract infections. J Infect Dis 1988;157:911-7. https://doi.org/10.1093/infdis/157.5.911
  15. Kawai Y, Miyashita N, Yamaguchi T, Saitoh A, Kondoh E, Fujimoto H, et al. Clinical efficacy of macrolide antibiotics against genetically determined macrolide-resistant Mycoplasma pneumoniae pneumonia in paediatric patients. Respirology 2012;17:354-62. https://doi.org/10.1111/j.1440-1843.2011.02102.x
  16. Miyashita N, Kawai Y, Inamura N, Tanaka T, Akaike H, Teranishi H, et al. Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults. J Infect Chemother 2015;21:153-60. https://doi.org/10.1016/j.jiac.2014.10.008
  17. Luo Z, Luo J, Liu E, Xu X, Liu Y, Zeng F, et al. Effects of prednisolone on refractory mycoplasma pneumoniae pneumonia in children. Pediatr Pulmonol 2014;49:377-80. https://doi.org/10.1002/ppul.22752
  18. Lu A, Wang C, Zhang X, Wang L, Qian L. Lactate dehydrogenase as a biomarker for prediction of refractory Mycoplasma pneumoniae pneumonia in children. Respir Care 2015;60:1469-75. https://doi.org/10.4187/respcare.03920
  19. Inamura N, Miyashita N, Hasegawa S, Kato A, Fukuda Y, Saitoh A, et al. Management of refractory Mycoplasma pneumoniae pneumonia: utility of measuring serum lactate dehydrogenase level. J Infect Chemother 2014;20:270-3. https://doi.org/10.1016/j.jiac.2014.01.001
  20. Zhang Y, Chen Y, Chen Z, Zhou Y, Sheng Y, Xu D, et al. Effects of bronchoalveolar lavage on refractory Mycoplasma pneumoniae pneumonia. Respir Care 2014;59:1433-9. https://doi.org/10.4187/respcare.03032