Yue Hongjuan, Sheng Qihong, Wang Xiaoyu, Cheng Zishuo, Zhang Mei, Wang Qian, Wang Lihong, Yu Weifang, Zhai Congjie, Wang Jia
Department of Infectious Diseases, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, China.
Department of Endoscopy Center, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050031, China.
Eur J Clin Microbiol Infect Dis. 2025 Apr 29. doi: 10.1007/s10096-025-05142-4.
Post-COVID-19, the increasing incidence of adult Mycoplasma pneumoniae pneumonia (MPP) necessitates attention, as it remains understudied due to its low incidence and undefined severity criteria. Therefore, exploring the characteristics of adult MPP and child MPP in terms of clinical diagnosis, treatment, and prognosis is of significant clinical importance. This study investigated the clinical features, severe risk factors, treatment, and prognosis of MPP in children and adults in Hebei, China, following the lifting of COVID-19 lockdown measures, offering insights for the diagnosis and treatment of MPP across age groups.
From May 2023 to March 2024, a total of 218 hospitalized MPP patients at the First Hospital of Hebei Medical University were enrolled, with children (≤ 14 years) and adults (≥ 18 years) randomly selected at a 1:1 ratio (109 children and 109 adults). Patient demographics and clinical data were recorded and analyzed to compare the diagnostic and treatment profiles of pediatric and adult MPP patients.
This study revealed that among 218 MPP patients, adult MPP patients differ significantly from child MPP patients in terms of clinical symptoms, the inflammatory response, coagulation status, and organ damage. In addition, C-reactive protein (CRP) (OR, 1.073; 95% CI, 1.032-1.116; P < 0.001) was a severe risk factor for adult MPP, whereas CRP, aspartate transaminase, and potassium (OR: 1.209, 1.124, 31.322; 95% CI: 1.072-1.362, 1.016-1.244, 3.112-315.213; P = 0.008, 0.02, 0.003) were positively associated with the severity of MPP in children. Interestingly, children and adults with MPP received different treatments, and adult MPP patients had shorter hospital stays but poorer lung infection resolution. The positive detection rate of macrolide-resistance genes was 70.8% (34/48). Compared with the macrolide-resistance MPP (MRMPP) subgroup in children (treated with macrolides), the MRMPP subgroup in adults (treated with quinolones) had shorter hospital stays and higher rates of improvement in lung infection (P < 0.05), and the recovery of eosinophil percentage, white blood cell count, neutrophil count and platelet-lymphocyte ratio was better.
In short, adult and child MPPs differ significantly in terms of clinical diagnosis, treatment, and prognosis. Early intervention for severe risk factors, monitoring MR genes and managing macrolides can lead to improved prognosis.
新冠疫情后，成人支原体肺炎（MPP）发病率不断上升，值得关注，因其发病率低且严重程度标准不明确，相关研究仍较少。因此，从临床诊断、治疗和预后方面探讨成人MPP和儿童MPP的特征具有重要的临床意义。本研究调查了中国河北地区在新冠疫情防控措施解除后儿童和成人MPP的临床特征、严重风险因素、治疗及预后情况，为各年龄段MPP的诊断和治疗提供参考。
2023年5月至2024年3月，河北医科大学第一医院共纳入218例住院MPP患者，按照1:1的比例随机选取儿童（≤14岁）和成人（≥18岁）各109例。记录并分析患者的人口统计学和临床数据，以比较儿童和成人MPP患者的诊断和治疗情况。
本研究发现，在218例MPP患者中，成人MPP患者与儿童MPP患者在临床症状、炎症反应、凝血状态和器官损害方面存在显著差异。此外，C反应蛋白（CRP）（OR，1.073；95%CI，1.032 - 1.116；P＜0.001）是成人MPP的严重风险因素，而CRP、天冬氨酸转氨酶和钾（OR：1.209，1.124，31.322；95%CI：1.072 - 1.362，1.016 - 1.244，3.112 - 315.213；P = 0.008，0.02，0.003）与儿童MPP的严重程度呈正相关。有趣的是，儿童和成人MPP患者接受的治疗不同。成人MPP患者住院时间较短，但肺部感染的缓解情况较差。大环内酯类耐药基因的阳性检出率为70.8%（34/48）。与儿童大环内酯类耐药MPP（MRMPP）亚组（接受大环内酯类治疗）相比，成人MRMPP亚组（接受喹诺酮类治疗）住院时间更短，肺部感染改善率更高（P＜0.05），嗜酸性粒细胞百分比、白细胞计数、中性粒细胞计数和血小板 - 淋巴细胞比值的恢复情况更好。
简而言之，成人和儿童MPP在临床诊断、治疗和预后方面存在显著差异。对严重风险因素进行早期干预、监测MR基因以及合理使用大环内酯类药物可改善预后。
