Resurgence of Macrolide‐Resistant
                    <scp>
                      <i>Mycoplasma pneumoniae</i>
                    </scp>
                    After the
                    <scp>COVID</scp>
                    ‐19 Pandemic at a Childre

doi:10.1111/ped.70513

DOI: 10.1111/ped.70513 ISSN: 1328-8067

Resurgence of Macrolide‐Resistant Mycoplasma pneumoniae After the COVID ‐19 Pandemic at a Childre

Natsuki Koriyama, Yo Murata, Shoichiro Shirane, Madoka Okabe, Shogo Akahoshi, Yuho Horikoshi, Hiroshi Sakakibara

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ABSTRACT

Background

Mycoplasma pneumoniae is a leading cause of pediatric community‐acquired pneumonia. Macrolide‐resistant M. pneumoniae (MRMP) emerged in East Asia in the 2000s and was once highly prevalent in Japan. However, its epidemiology in Japan following the coronavirus disease 2019 (COVID‐19) pandemic is unclear.

Methods

The present, single‐center, retrospective study, conducted at a tertiary children's hospital in Tokyo, investigated the post‐pandemic prevalence of MRMP and compared the clinical features of MRMP and macrolide‐susceptible M. pneumoniae (MSMP). Patients aged ≤ 18 years who were positive for M. pneumoniae on polymerase chain reaction (PCR) between April 2020 and March 2025 were enrolled. MRMP was defined by macrolide‐resistance mutations detected using a point‐of‐care, PCR‐based assay. The proportion of patients with MRMP and the clinical characteristics of the MRMP and MSMP cohorts were analyzed.

Results

In total, 272 patients had a M. pneumoniae infection, and 191 (70.2%) patients were classified into the MRMP group. A marked resurgence of M. pneumoniae infections, of which MRMP comprised 87% of the cases, was observed in April 2024 and peaked in October 2024. Among hospitalized patient (52/272, 19.1%), MRMP group were more likely to require oxygen (89% vs. 43%, p = 0.0015), and experience respiratory complications (47% vs. 7.1%, p = 0.019) than MSMP group.

Conclusion

MRMP reemerged as the predominant strain in Tokyo following the COVID‐19 pandemic and may be associated with greater severity and recalcitrance to treatment. Therefore, monitoring its prevalence and adjusting the antibiotic strategy are crucial.