Emerg Infect Dis. 2020 Jul;26(7):1382-1391. doi: 10.3201/eid2607.200017.
A high prevalence rate of macrolide-resistant Mycoplasma pneumoniae (MRMP) has been reported in Asia. We performed a systematic review and meta-analysis to investigate the effect of macrolide resistance on the manifestations and clinical judgment during M. pneumoniae infections. We found no difference in clinical severity between MRMP and macrolide-sensitive Mycoplasma pneumoniae (MSMP) infections. However, in the pooled data, patients infected with MRMP had a longer febrile period (1.71 days), length of hospital stay (1.61 day), antibiotic drug courses (2.93 days), and defervescence time after macrolide treatment (2.04 days) compared with patients infected with MSMP. The risk of fever lasting for >48 hours after macrolide treatment was also significantly increased (OR 21.24), and an increased proportion of patients was changed to second-line treatment (OR 4.42). Our findings indicate diagnostic and therapeutic challenges after the emergence of MRMP. More precise diagnostic tools and clearly defined treatment should be appraised in the future.
大环内酯类耐药肺炎支原体（MRMP）在亚洲的流行率很高。我们进行了系统评价和荟萃分析，以研究大环内酯类耐药性对肺炎支原体感染时临床表现和临床判断的影响。我们发现大环内酯类耐药和大环内酯类敏感肺炎支原体（MSMP）感染的临床严重程度没有差异。然而，在汇总数据中，与 MSMP 感染患者相比，MRMP 感染患者的发热期（1.71 天）、住院时间（1.61 天）、抗生素疗程（2.93 天）和大环内酯类治疗后退热时间（2.04 天）更长。大环内酯类治疗后发热持续>48 小时的风险也显著增加（OR 21.24），更多的患者需要更换二线治疗（OR 4.42）。我们的研究结果表明，MRMP 出现后带来了诊断和治疗的挑战。未来应评估更精确的诊断工具和明确的治疗方法。
