Abstract
Abstract
Background
Cases of refractory Mycoplasma pneumoniae pneumonia have been increasing recently; however, whether viral coinfection or macrolide-resistant M. infection contribute to the development of refractory M. pneumoniae pneumonia remains unclear. This study aimed to investigate the impacts of viral coinfection and macrolide-resistant M. pneumoniae infection on M. pneumoniae pneumonia in hospitalized children and build a model to predict a severe disease course.
Methods
Nasopharyngeal swabs or sputum specimens were collected from patients with community-acquired pneumonia meeting our protocol who were admitted to Shanghai Children’s Medical Center from December 1, 2016, to May 31, 2019. The specimens were tested with the FilmArray Respiratory Panel, a multiplex polymerase chain reaction assay that detects 16 viruses, Bordetella pertussis, M. pneumoniae, and Chlamydophila pneumoniae. Univariate and multivariate logistic regression models were used to identify the risk factors for adenovirus coinfection and macrolide-resistant mycoplasma infection.
Results
Among the 107 M. pneumoniae pneumonia patients, the coinfection rate was 56.07%, and 60 (60/107, 56.07%) patients were infected by drug-resistant M. pneumoniae. Adenovirus was the most prevalent coinfecting organism, accounting for 22.43% (24/107). The classification tree confirmed that viral coinfection was more common in patients younger than 3 years old. Adenovirus coinfection and drug-resistant M. pneumoniae infection occurred more commonly in patients with refractory M. pneumoniae pneumonia (P = 0.019; P = 0.001). A prediction model including wheezing, lung consolidation and extrapulmonary complications was used to predict adenovirus coinfection. The area under the receiver operating characteristic curve of the prediction model was 0.795 (95% CI 0.679–0.893, P < 0.001). A prolonged fever duration after the application of macrolides for 48 h was found more commonly in patients infected by drug-resistant M. pneumoniae (P = 0.002). A fever duration longer than 7 days was an independent risk factor for drug-resistant Mycoplasma infection (OR = 3.500, 95% CI = 1.310–9.353, P = 0.012).
Conclusions
The occurrence of refractory M. pneumoniae pneumonia is associated with adenovirus coinfection and infection by drug-resistant M. pneumoniae. A prediction model combining wheezing, extrapulmonary complications and lung consolidation can be used to predict adenovirus coinfection in children with M. pneumoniae pneumonia. A prolonged fever duration indicates drug-resistant M. pneumoniae infection, and a reasonable change in antibiotics is necessary.
Funder
Collaborative Innovation Center for Translational Medicine at Shanghai Jiao Tong University School of Medicine
Clinical Science and Technology Innovation (clinical research and cultivation) project
Interdisciplinary Program of Shanghai Jiao Tong University
Publisher
Springer Science and Business Media LLC
Reference36 articles.
1. Gendrel D, Raymond J, Moulin F, et al. Etiology and response to antibiotic therapy of community-acquired pneumonia in French children. Eur J Clin Microbiol Infect Dis. 1997;16(5):388–91.
2. Sztrymf B, Jacobs F, Fichet J, et al. Mycoplasma-related pneumonia: a rare cause of acute respiratory distress syndrome (ARDS) and of potential antibiotic resistance[J]. Rev Mal Respir. 2013;30(1):77–80.
3. Tamura A, Matsubara K, Tanaka T, et al. Methylprednisolone pulse therapy for refractory mycoplasma pneumoniae pneumonia in children[J]. J Inf Secur. 2008;57(3):223–8.
4. Koichi I. Clinical features of severe or fatal mycoplasma pneumoniae pneumonia[J]. Front Microbiol. 2016;7:800.
5. Yu JL, Song QF, Xie ZW, Jiang WH, Chen JH, Fan HF, et al. An iTRAQ-based quantitative proteomics study of refractory mycoplasma pneumoniae pneumonia patients. Jpn J Infect Dis. 2017;70(5):571–8.
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