Kang Dayun, Yun Ki Wook, Lee Taekjin, Cho Eun Young, Eun Byung Wook, Lee Joon Kee, Kim Yae-Jean, Kim Doo Ri, Shin Areum, Kang Hyun Mi, Kim Ye Ji, Kim Dong Hyun, Choi Young June, Lee Hyunju, Cho Youngmin, Kwak Byung Ok, Jo Kyo Jin, Choi Jae Hong, Choi Eun Hwa, Park Su Eun
Department of Paediatrics, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
Department of Paediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Sci Rep. 2025 Apr 28;15(1):14860. doi: 10.1038/s41598-025-99537-0.
Mycoplasma pneumoniae is the leading cause of community-acquired pneumonia in children. With increasing macrolide resistance, the use of second-line antibiotics such as tetracyclines and quinolones is also increasing. Clinical data were collected from 13 institutions between September 2023 and February 2024. MPP was defined as the detection of M. pneumoniae via polymerase chain reaction or serological tests and radiologic evidence of pneumonic infiltration. Among the 389 children with MPP included in the analysis, 89.1% were macrolide resistant (MR). The treatment groups were as follows: spontaneous resolution (SR, 21.9%), macrolide alone (ML, 18.0%), macrolide with other treatments (ML-O, 38.0%), and second-line antibiotics and/or steroids (2nd-A/S, 22.1%). The median fever duration was 5 days for the SR group, 7 days for both the ML and 2nd-A/S groups, and 8 days for the ML-O group. The ML-O group had significantly greater hospitalization rates (93.9% vs. 81.4-84.7%, P = 0.023) and longer hospital stays (5.0 days vs. 3.0-4.0 days, P < 0.001). The median times to defervescence from the initiation of macrolide and second-line treatments were 2-3 days and 0-2 days, respectively. In conclusion, despite high MR rates, macrolide monotherapy remains effective in many patients, even those with macrolide-resistant M. pneumoniae.
肺炎支原体是儿童社区获得性肺炎的主要病因。随着大环内酯类耐药性的增加，四环素和喹诺酮类等二线抗生素的使用也在增加。2023年9月至2024年2月期间从13家机构收集了临床数据。MPP定义为通过聚合酶链反应或血清学检测检测到肺炎支原体以及有肺部浸润的放射学证据。纳入分析的389例MPP患儿中，89.1%对大环内酯类耐药（MR）。治疗组如下：自行缓解（SR，21.9%）、单用大环内酯类（ML，18.0%）、大环内酯类联合其他治疗（ML-O，38.0%）以及二线抗生素和/或类固醇（2nd-A/S，22.1%）。SR组发热持续时间中位数为5天，ML组和2nd-A/S组均为7天，ML-O组为8天。ML-O组的住院率显著更高（93.9%对81.4-84.7%，P = 0.023），住院时间更长（5.0天对3.0-4.0天，P < 0.001）。从开始使用大环内酯类和二线治疗到退热的中位时间分别为2-3天和0-2天。总之，尽管MR率很高，但大环内酯类单药治疗对许多患者仍然有效，即使是对大环内酯类耐药的肺炎支原体患者。
