Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
Microbiol Spectr. 2022 Feb 23;10(1):e0155021. doi: 10.1128/spectrum.01550-21. Epub 2022 Feb 9.
Mycoplasma pneumoniae is a common pathogen causing respiratory disease in children. We sought to investigate the epidemiology of M. pneumoniae among outpatient children with mild respiratory tract infections (RTIs) during the coronavirus disease 2019 (COVID-19) pandemic. Eligible patients were prospectively enrolled from January 2020 to June 2021. Throat swabs were tested for M. pneumoniae RNA. M. pneumoniae IgM was tested by a colloidal gold assay. Macrolide resistance and the effect of the COVID-19 countermeasures on M. pneumoniae prevalence were assessed. Symptom scores, treatments, and outcomes were evaluated. Eight hundred sixty-two eligible children at 15 centers in China were enrolled. M. pneumoniae was detected in 78 (9.0%) patients. Seasonally, M. pneumoniae peaked in the first spring and dropped dramatically to extremely low levels over time until the next summer. Decreases in COVID-19 prevalence were significantly associated with decreases in M. pneumoniae prevalence (=0.76, 0.001). The macrolide resistance rate was 7.7%. The overall sensitivity and specificity of the colloidal gold assay used in determining M. pneumoniae infection were 32.1% and 77.9%, respectively. No more benefits for improving the severity of symptoms and outcomes were observed in M. pneumoniae-infected patients treated with a macrolide than in those not treated with a macrolide during follow-up. The prevalences of M. pneumoniae and macrolide resistance in outpatient children with mild RTIs were at low levels in the early stage of the COVID-19 pandemic but may have rebounded recently. The colloidal gold assay for M. pneumoniae IgM may be not appropriate for diagnosis of M. pneumoniae infection. Macrolides should be used with caution among outpatients with mild RTIs. This is the first and largest prospective, multicenter, active, population-based surveillance study of the epidemiology of Mycoplasma pneumoniae among outpatient children with mild respiratory tract infections (RTIs) during the COVID-19 pandemic. Nationwide measures like strict face mask wearing and restrictions on population movement implemented to prevent the spread of COVID-19 might also effectively prevent the spread of M. pneumoniae. The prevalence of M. pneumoniae and the proportion of drug-resistant M. pneumoniae isolates in outpatient children with mild RTIs were at low levels in the early stage of the COVID-19 pandemic but may have rebounded recently. The colloidal gold assay for M. pneumoniae IgM may be not appropriate for screening and diagnosis of M. pneumoniae infection. Macrolides should be used with caution among outpatients with mild RTIs.
肺炎支原体是引起儿童呼吸道疾病的常见病原体。我们旨在研究 2019 年冠状病毒病（COVID-19）大流行期间门诊轻症呼吸道感染（RTI）患儿肺炎支原体的流行病学。2020 年 1 月至 2021 年 6 月，前瞻性纳入符合条件的患者。采用咽拭子检测肺炎支原体 RNA，胶体金法检测肺炎支原体 IgM。评估大环内酯类耐药性和 COVID-19 对策对肺炎支原体流行率的影响。评估症状评分、治疗和结局。在中国 15 个中心的 862 名符合条件的儿童被纳入。78 例（9.0%）患儿检测出肺炎支原体。季节性方面，肺炎支原体于第一个春季达到高峰，随后逐渐下降，直至次年夏季降至极低水平。COVID-19 流行率的下降与肺炎支原体流行率的下降显著相关（=0.76，0.001）。大环内酯类耐药率为 7.7%。胶体金法用于确定肺炎支原体感染的总灵敏度和特异性分别为 32.1%和 77.9%。在随访期间，与未使用大环内酯类治疗的患者相比，使用大环内酯类治疗的肺炎支原体感染患者的症状严重程度和结局改善并无更多获益。在 COVID-19 大流行早期，门诊轻症 RTI 患儿肺炎支原体和大环内酯类耐药率处于低水平，但近期可能有所反弹。胶体金法检测肺炎支原体 IgM 可能不适合诊断肺炎支原体感染。轻症 RTI 门诊患者应谨慎使用大环内酯类药物。这是 COVID-19 大流行期间门诊轻症 RTI 患儿肺炎支原体流行病学的首个也是最大的前瞻性、多中心、主动、基于人群的监测研究。为防止 COVID-19 传播而实施的严格戴口罩和人口流动限制等全国性措施，也可能有效防止肺炎支原体的传播。在 COVID-19 大流行早期，门诊轻症 RTI 患儿肺炎支原体的流行率和耐药肺炎支原体分离株的比例均处于较低水平，但近期可能有所反弹。胶体金法检测肺炎支原体 IgM 可能不适合筛选和诊断肺炎支原体感染。轻症 RTI 门诊患者应谨慎使用大环内酯类药物。
