Mycoplasma pneumoniae (MP) is a common cause of community-acquired respiratory infections in children, with manifestations ranging from mild upper respiratory tract illnesses to pneumonia. Mycoplasma pneumoniae pneumonia (MPP) represents a more severe form of infection that often necessitates medical intervention. In children diagnosed with MPP, antimicrobial agents active against MP are indicated, and macrolide antibiotics represent the first-line therapy. However, macrolide-resistant MP (MRMP) strains have emerged worldwide, with a notable upward trend in both MP infection incidence and resistance rates, particularly in East Asia. This study aimed to investigate the prevalence of MP infection and the emergence of macrolide resistance in children during a period of elevated incidence, as well as to explore the underlying factors contributing to severe MPP (SMPP) among children in Guangzhou City. The study enrolled a total of 10,328 children suspected of having MP infection from November 2023 to December 2024. Respiratory tract specimens were collected from the study subjects and then analyzed using real-time polymerase chain reaction (PCR) to detect MP DNA and mutations associated with macrolide resistance at positions A2063G or A2064G. Moreover, demographic data and information on co-infecting common respiratory pathogens were collected during this analysis, and the risk factors for SMPP were analyzed. The positive detection rate of MP was 25.8%, and it decreased from 30.3% in the fourth quarter of 2023 (Q4 2023) to 10.1% in the fourth quarter of 2024 (Q4 2024). The highest positive rate of MP detection was among children aged 5–9 years, followed by those aged 10–14 years and 1–4 years. The detection rate of MRMP in MP-positive cases was 49.4%, and it rose from 37.8% in Q4 2023 to 61.9% in Q4 2024. Among the 1,905 pneumonia inpatients who tested positive for MP, 7.4% (141/1,905) were found to have co-infection with other common respiratory pathogens. The most prevalent co-infecting pathogens were human rhinovirus (RHV), human adenovirus (HADV), and influenza A virus (IAV). Detection of MRMP (OR = 1.833, 95% CI: 1.189–2.824, p = 0.006), presence of co-infection (OR = 2.209, 95% CI: 1.111–4.391, p = 0.0024), and existence of comorbidities (OR = 4.431, 95% CI: 1.833–10.715, p = 0.001) were associated with an increased risk of SMPP. We reported that during the epidemic period of MP in children, the MRMP positive rate remained persistently high across all age groups in a cohort comprising both outpatients and inpatients. Among hospitalized children with MPP, those with MRMP detection, co-infection with other respiratory pathogens, or underlying comorbidities were more likely to develop severe conditions. These findings suggest that monitoring MRMP in children at potential high risk, particularly those who requiring hospitalization, may be essential for the development of effective prevention and treatment strategies.
Kuang et al. (Fri,) studied this question.