Journal List > Allergy Asthma Respir Dis > v.6(1) > 1095717

Choi, Seo, Lee, and Choi: Clinical analysis of risk factors in refractory mycoplasma pneumonia in children

Abstract

Purpose

Refractory Mycoplasma pneumonia (RMP) has been increasing not only in Korea but worldwide. We investigated the incidence of M. pneumonia resistant to macrolides and risk factors for RMP.

Methods

From October 2015 to May 2016, 62 pediatric patients who were admitted due to pneumonia diagnosed on the basis of chest x-ray with respiratory symptoms and positive for M. pneumoniae in polymerase chain reaction with no evidence of other bacterial or viral infections were included. Sequence analysis of the 23S rRNA gene in M. pneumoniae was performed to identify macrolide resistance. Patients with congenital anomalies, history of pulmonary disease, and unclear information on antibiotic use were ex-cluded.

Results

Mutations in the 23S rRNA gene were detected in 50 of 62 patients (80.6%). Risk factors were analyzed in only 45 patients. The RMP group consisted of 26 patients (57.8%) who had fever lasting more than 5 days and deteriorating chest x-ray findings. The lactate dehydrogenase (LDH) and C-reactive protein (CRP) levels were significantly higher in the RMP group than in the non-RMP group (LDH: 300±79 U/L vs. 469±206 U/L, CRP: 4.9±4.3 mg/dL vs. 2.5±1.7 mg/dL; P=0.04 vs. P=0.026). In univariate analysis, the RMP group was significantly associated with 23S rRNA gene mutation, lobar pneumonia, and pleural effusion (odds ration [OR]: 10.8, 4.1, 5.3; P=0.004, P=0.036, P=0.046). The presence of macrolide resistance was found to be only a significant risk factor in logistic regression (OR; 8.827; 95% confidence interval, 1.376–56.622; P=0.022).

Conclusion

Macrolide resistance was a significant risk factor in patients with RMP and identification of macrolide resistance might be helpful in predicting RMP and establishing target therapy for RMP.

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Fig. 1.
The schematic outline of study. PCR, polymerase chain reaction.
aard-6-62f1.tif
Fig. 2.
Electropherogram shows the point mutation A2063G in domain V of 23S rRNA.
aard-6-62f2.tif
Table 1.
The difference of clinical characteristics between NRMP and RMP patients
Variable NRMP (n=19) RMP (n=26) P-value
Duration of symptom (day) 4.3±1.7 5.4±2.6 0.139
Age (yr) 6.8±3.9 6.5±4.0 0.727
WBC (/mm3) 8,323±2,587 8,198±6,022 0.931
Neutrophil (%) 87.6±108.0 66.2±11.7 0.319
CRP (mg/dL) 2.5±1.7 4.9±4.3 0.026
LDH (U/L) 300.9±79.9 469.6±206.2 0.040
ESR (mm/hr) 29.8±14.7 37.1±18.4 0.169
Mutation 9 (47.3) 24 (92.3) 0.004
Pneumonia type     0.017
 Lobar 6 (31.6) 17 (65.4)  
 Interstitial 0 (0) 2 (7.7)  
 Bronchial 13 (68.4) 7 (26.9)  
Pleural effusion 2 (10.5) 10 (38.5) 0.046
Duration of fever (day) 1.8±0.9 6.0±1.9 <0.001
Duration of admission (day) 5.1±1.4 9.4±3.6 <0.001

Values are presented as mean±standard deviation or number (%).

NRMP, nonrefractory Mycoplasma pneumoniae pneumonia; RMP, refractory Mycoplasma pneumoniae pneumonia; WBC, white blood cell; CRP, C-reactive protein; LDH, lactate dehydrogenase; ESR, erythrocyte sedimentation rate.

Duration of symptom (fever) before admission.

Initial laboratory results at admission day.

Duration of fever after starting medication.

Table 2.
Analysis of risk factors on refractory mycoplasma pneumonia patients
Variable RMP (n=26) Unadjusted OR (95% CI) Adjusted OR (95% CI) P-value
Male sex 14 (53.8) 1.18 (0.36–3.89) 0.86 (0.19–3.90) 0.862
Age ≥7 yr 8 (30.8) 0.49 (0.15–1.68) 0.44 (0.09–2.06) 0.295
Mutation 24 (92.3) 10.80 (1.97–59.15) 8.83 (1.38–56.62) 0.022
Lobar pneumonia 17 (65.4) 4.09 (1.16–14.43) 3.14 (0.57–17.38) 0.190
Pleural effusion 10 (38.5) 5.31 (1.01–28.07) 1.77 (0.19–16.88) 0.620
RMP, refractory Myc interval. 23S rRNA gene mu coplasma pneu utation, A2063 umoniae pneumonia; 3G. OR, odds ratio; Cl, c onfidence

RMP, refractory Mycoplasma pneumoniae pneumonia; OR, odds ratio; Cl, confidence interval.

23S rRNA gene mutation, A2063G.

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