DOI: 10.4103/prcm.prcm_12_26 ISSN: 2543-0343
Prevalence and Treatment of Macrolide-Resistant Mycoplasma pneumoniae Infections in Singapore
Kei Him Samson Cheung, Liat Hui Loo, Nancy Wen Sim Tee, Anne Eng Neo Goh Abstract
Background:
Mycoplasma pneumoniae
infection is a common cause of community-acquired pneumonia in children. Defining characteristics of the clinical presentation may improve diagnosis of the disease and allow appropriate treatment to be instituted. Furthermore, there are also increasing reports of macrolide resistance in Asia. We, therefore, aim to characterise the clinical features of
M. pneumoniae
infection in Singapore and review the impact of macrolide resistance.
Methods:
A total of 345 children admitted in 2013 who were positive for
M. pneumoniae
infection identified by real-time polymerase chain reaction were retrospectively reviewed. The domain V region of the 23S rRNA gene was amplified and sequenced to look for the mutations associated with macrolide resistance from throat swab samples. Data on demographic, clinical, laboratory and radiology features, as well as treatment and outcome variables were collected. Statistical comparisons were done between macrolide-resistant and -sensitive groups.
Results:
There were 157 boys (45.5%) and 188 girls (54.5%) with a median age of 6.0 years. The disease spectrum ranged from upper respiratory tract infections to complicated pneumonia with effusion. A total of 21/180 (11.6%) of the isolates had mutations for macrolide resistance. The presence of the mutation was not associated with disease severity but was significantly associated with a longer total duration of fever and hospital stay. The change of antibiotics from macrolides to fluoroquinolones was not associated with a shorter duration of fever.
Conclusion:
M. pneumoniae
infection affects children of school-going age, manifesting from mild-to-severe disease. The presence of the mutation causing macrolide resistance did not affect disease severity, and the majority will still respond to macrolides.