Cheng Jie, Liu Ya, Zhang Guangli, Li Yuanyuan, Tian Xiaoyin, Tan Liping, Luo Zhengxiu
Department of Emergency, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Intelligent Application of Big Data in Pediatrics Engineering Research Center of Chongqing Education Commission of China, Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Pediatrics, Chongqing Youyoubaobei Women and Children's Hospital, Chongqing, China.
Front Cell Infect Microbiol. 2025 Jun 27;15:1604102. doi: 10.3389/fcimb.2025.1604102. eCollection 2025.
We aimed to investigate prognostic indicators for pediatric macrolides-unresponsive pneumonia (MUMPP) cases with A2063/2064G mutations with azithromycin therapy.
This was a retrospective observational cohort study conducted at the Children's Hospital of Chongqing Medical University. Children with macrolide-resistant mutations (A2063/2064G) diagnosed as MUMPP who received only anti- (MP) treatment with azithromycin were retrospectively enrolled. Logistic regression analysis was used to identify potential risk factors for predicting short-term (refractory pneumonia [RMPP]) and long-term (bronchiolitis obliterans [BO] or bronchiectasis) adverse prognosis. The results were visualized using forest plots.
This study retrospectively included 82 children with MUMPP, and all received only azithromycin for anti-MP treatment. The incidence of pulmonary consolidation, pleural effusion, and atelectasis was 80.49% (66/82), 34.15% (28/82), and 24.39% (20/82), respectively. 29.27% (24/82) of patients diagnosed with RMPP, and 14.63% (12/82) of patients diagnosed with bronchiolitis obliterans (BO) or bronchiectasis diagnosed within one year after discharge. Logistic analysis showed that atelectasis was independently associated with short-term (RMPP) and long-term (BO or bronchiectasis) adverse prognosis (odds ratio [OR] 4.02, 95% confidence interval [CI] 1.03-16.00, P = 0.043; OR 5.62, 95% CI 1.04-32.80, P = 0.045; respectively).
Atelectasis predicts a poor prognosis for children with A2063/2064G MUMPP. The occurrence of atelectasis may indicate an increased risk of failure of current azithromycin treatment. Combined with the results of drug-resistant mutations, it is recommended to strengthen disease monitoring and individualized intervention evaluation.
我们旨在研究A2063/2064G突变的小儿大环内酯类无反应性肺炎（MUMPP）病例接受阿奇霉素治疗的预后指标。
这是一项在重庆医科大学附属儿童医院进行的回顾性观察队列研究。回顾性纳入诊断为MUMPP且携带大环内酯类耐药突变（A2063/2064G）并仅接受阿奇霉素抗（MP）治疗的儿童。采用逻辑回归分析确定预测短期（难治性肺炎[RMPP]）和长期（闭塞性细支气管炎[BO]或支气管扩张）不良预后的潜在危险因素。结果用森林图进行可视化展示。
本研究回顾性纳入82例MUMPP患儿，均仅接受阿奇霉素抗MP治疗。肺部实变、胸腔积液和肺不张的发生率分别为80.49%（66/82）、34.15%（28/82）和24.39%（20/82）。29.27%（24/82）的患者诊断为RMPP，14.63%（12/82）的患者在出院后1年内诊断为闭塞性细支气管炎（BO）或支气管扩张。逻辑分析显示，肺不张与短期（RMPP）和长期（BO或支气管扩张）不良预后独立相关（优势比[OR]分别为4.02，95%置信区间[CI]为1.03 - 16.00，P = 0.043；OR为5.62，95%CI为1.04 - 32.80，P = 0.045）。
肺不张预示A2063/2064G MUMPP患儿预后不良。肺不张的出现可能表明当前阿奇霉素治疗失败风险增加。结合耐药突变结果，建议加强疾病监测和个体化干预评估。
