Li Yun, Liu Yunwei, Chen Xinying, Xiao Xiaolan, Chen Yiting, Wang Lianyu, Jiang Wenwen, Yang Jinghua
Department of Pediatrics, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
Xiaorong Luo's National Renowned Expert Inheritance Studio, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
Front Pediatr. 2024 Dec 3;12:1489389. doi: 10.3389/fped.2024.1489389. eCollection 2024.
Macrolide-unresponsive pneumonia (MUMPP) cases have been rapidly increasing. The primary reason for this increased incidence is the pathogen's acquisition of resistance through mutations in 23S rRNA genes. Due to the unfeasibility of testing for macrolide susceptibility at the time of admission, this study aimed to assess the clinical features of pediatric MUMPP, using insights from laboratory tests and patterns of chest radiographic resolution.
We conducted a retrospective review of 161 patients with pneumonia (MPP) between January 2023 and December 2023. These patients were categorized into two groups based on their responsiveness to macrolides: 72 patients were in the MUMPP group, and 89 patients were in the macrolide-sensitive pneumonia (MSMP) group.
MUMPP patients experienced a longer duration of fever and hospital stay. A higher proportion of MUMPP patients had shortness of breath, transcutaneous blood oxygen saturation (SpO) lower than 94%, bilateral lobar infiltrates, lobar pneumonia and pleural effusion. The serum level of serum ferritin (SF), interleukin-6(IL-6), D-dimer, lactate dehydrogenase to albumin rate (LAR), and neutrophil to lymphocyte rate (NLR) were higher in MUMPP group.
Our findings revealed that patients with MUMPP exhibit more severe initial radiographic indicators and clinical course compared to those with MSMP. Therefore, it is crucial to promptly administer alternative therapeutic agents besides macrolides for the management of MUMPP.
大环内酯类耐药性肺炎（MUMPP）病例一直在迅速增加。发病率上升的主要原因是病原体通过23S rRNA基因突变获得耐药性。由于入院时检测大环内酯类药物敏感性不可行，本研究旨在利用实验室检查结果和胸部X线片的吸收模式来评估儿童MUMPP的临床特征。
我们对2023年1月至2023年12月期间的161例肺炎（MPP）患者进行了回顾性研究。根据患者对大环内酯类药物的反应性将其分为两组：72例患者为MUMPP组，89例患者为大环内酯类敏感肺炎（MSMP）组。
MUMPP患者发热持续时间和住院时间更长。MUMPP患者中呼吸急促、经皮血氧饱和度（SpO）低于94%、双侧大叶浸润、大叶性肺炎和胸腔积液的比例更高。MUMPP组血清铁蛋白（SF）、白细胞介素-6（IL-6）、D-二聚体、乳酸脱氢酶与白蛋白比值（LAR）和中性粒细胞与淋巴细胞比值（NLR）水平更高。
我们的研究结果表明，与MSMP患者相比，MUMPP患者的初始影像学指标和临床病程更为严重。因此，对于MUMPP的治疗，除了大环内酯类药物外，及时给予替代治疗药物至关重要。
