Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

Ying-Shuo Wang ¹Yun-Lian Zhou ¹Guan-Nan Bai ²Shu-Xian Li ¹Dan Xu ¹Li-Na Chen ³Xing Chen ⁴Xiao-Yan Dong ⁵Hong-Min Fu ⁶Zhou Fu ⁷Chuang-Li Hao ⁸Jian-Guo Hong ⁹En-Mei Liu ⁷Han-Min Liu ³Xiao-Xia Lu ¹⁰Zheng-Xiu Luo ⁷Lan-Fang Tang ¹Man Tian ¹¹Yong Yin ¹²Xiao-Bo Zhang ¹³Jian-Hua Zhang ¹⁴Hai-Lin Zhang ¹⁵De-Yu Zhao ¹¹Shun-Ying Zhao ¹⁶Guo-Hong Zhu ¹Ying-Xue Zou ¹⁷Quan Lu ⁵Yuan-Yuan Zhang ¹Zhi-Min Chen¹

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作者信息

1. Department of Pulmonology,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China
2. Department of Child Health Care,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China
3. Department of Pediatric Pulmonology and Immunology,West China Second University Hospital,Sichuan University Chengdu 610041,China
4. Department of Pediatrics,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China
5. Department of Pulmonology,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China
6. Department of Pulmonary and Critical Care Medicine,Kunming Children's Hospital,Kunming 650034,China
7. Department of Respiratory Medicine,Children's Hospital of Chongqing Medical University,Chongqing 400014,China
8. Department of Pulmonology,Children's Hospital of Soochow University,Suzhou 215003,China
9. Department of Pediatrics,Shanghai General Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200080,China
10. Department of Respiratory Medicine,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430015,China
11. Department of Respiratory Medicine,Children's Hospital of Nanjing Medical University Nanjing 210008,China
12. Department of Respiratory Medicine,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China
13. Department of Respiratory Medicine,Children's Hospital of Fudan University,Shanghai 201102,China
14. Department of Pediatric Pulmonology,Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201102,China
15. Depa-rtment of Pediatric Respiratory Medicine,the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou 325027,China
16. National Clinical Research Center for Respiratory Diseases,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China
17. Department of Pulmonology,Tianjin Children's Hospital(Children's Hospital of Tianjin University),Tianjin 300074,China
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Abstract

Background Mycoplasma pneumoniae(M.pneumoniae)is a significant contributor to community-acquired pneumonia among children.Since 1968,when a strain of M.pneumoniae resistant to macrolide antibiotics was initially reported in Japan,macrolide-resistant M.pneumoniae(MRMP)has been documented in many countries worldwide,with varying incidence rates.MRMP infections lead to a poor response to macrolide antibiotics,frequently resulting in prolonged fever,extended antibiotic treatment,increased hospitalization,intensive care unit admissions,and a significantly higher proportion of patients receiving glucocorticoids or second-line antibiotics.Since 2000,the global incidence of MRMP has gradually increased,especially in East Asia,which has posed a serious challenge to the treatment of M.pneumoniae infections in children and attracted widespread attention from pediatricians.However,there is still no global consensus on the diagnosis and treatment of MRMP in children.Methods We organized 29 Chinese experts majoring in pediatric pulmonology and epidemiology to write the world's first consensus on the diagnosis and treatment of pediatric MRMP pneumonia,based on evidence collection.The evidence searches and reviews were conducted using electronic databases,including PubMed,Embase,Web of Science,CNKI,Medline,and the Cochrane Library.We used variations in terms for"macrolide-resistant","Mycoplasma pneumoniae","MP","M.pneumoniae","pneumonia","MRMP","lower respiratory tract infection","Mycoplasma pneumoniae infection","children",and"pediatric".Results Epidemiology,pathogenesis,clinical manifestations,early identification,laboratory examination,principles of anti-biotic use,application of glucocorticoids and intravenous immunoglobulin,and precautions for bronchoscopy are highlighted.Early and rapid identification of gene mutations associated with MRMP is now available by polymerase chain reaction and fluorescent probe techniques in respiratory specimens.Although the resistance rate to macrolide remains high,it is fortunate that M.pneumoniae still maintains good in vitro sensitivity to second-line antibiotics such as tetracyclines and quinolones,making them an effective treatment option for patients with initial treatment failure caused by macrolide antibiotics.Conclusions This consensus,based on international and national scientific evidence,provides scientific guidance for the diagnosis and treatment of MRMP in children.Further studies on tetracycline and quinolone drugs in children are urgently needed to evaluate their effects on the growth and development.Additionally,developing an antibiotic rotation treatment strategy is necessary to reduce the prevalence of MRMP strains.

Key words

Child/Macrolide-resistant Mycoplasma pneumoniae/Recommendation/Diagnosis/Treatment

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基金项目

Key R & D Projects of Zhejiang Province(2023C03009)

Key R & D Projects of Zhejiang Province(2024C03177)

出版年

2024

世界儿科杂志(英文版)

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参考文献量98

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