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Allergy Asthma Respir Dis. 2018 Jan;6(1):62-67. Korean.
Published online Jan 31, 2018.  https://doi.org/10.4168/aard.2018.6.1.62
© 2018 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
Clinical analysis of risk factors in refractory mycoplasma pneumonia in children
Seo Yeol Choi,1 Ju-Hee Seo,1 Kunsong Lee,1 and Qute Choi2
1Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea.
2Department of Laboratory Medicine, Dankook University College of Medicine, Cheonan, Korea.

Correspondence to: Kunsong Lee. Department of Pediatrics, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: +82-41-550-3968, Fax: +82-41-550-3949, Email: pdlks@dankook.ac.kr
Received June 28, 2017; Revised August 20, 2017; Accepted August 30, 2017.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).


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 excluded.

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.

Keywords: Mycoplasma; Refractory; Mutation; Resistant; Child

Figures


Fig. 1
The schematic outline of study. PCR, polymerase chain reaction.
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Fig. 2
Electropherogram shows the point mutation A2063G in domain V of 23S rRNA.
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Tables


Table 1
The difference of clinical characteristics between NRMP and RMP patients
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Table 2
Analysis of risk factors on refractory mycoplasma pneumonia patients
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