Epidemiology and Clinical Manifestations of Children
With Macrolide-Resistant Mycoplasma pneumonia Pneumonia in Taiwan
Ping-Sheng Wu, MD,1 Luan-Yin Chang, MD, PhD,2 Hsiao-Chuan Lin, MD,3 Hsin
Chi, MD,4
Yu-Chia Hsieh, MD, PhD,5 Yi-Chuan Huang, MD,6 Ching-Chuan Liu, MD, MPH,7
Yhu-Chering Huang, MD, PhD,5* and Li-Min Huang, MD, PhD
2**
Summary. Mycoplasma pneumoniae accounts for 10–30% of community-acquired
pneumonia (CAP) in children. This study reveals the epidemiology and clinical
manifestations of children with macrolide-resistant (MLr) M. pneumoniae pneumonia
in Taiwan. Respiratory tract specimens were collected from children hospitalized with
CAP for evaluation via PCR followed by DNA sequencing for several point mutations
related to the MLr character. Of the 412 specimens collected during the study period,
60 (15%) were positive for M. pneumoniae, 14 (23%) of which presented point
mutation (all A2063G) in 23S rRNA. Clinical symptoms and chest Xray findings
between the MLs and MLr groups were not significantly different. However, the MLr
group had longer mean duration of fever after azithromycin treatment (3.2 days vs.1.6
days, P 1 0.02) and significantly higher percentage of changing antibiotics for
suspected MLr strain(42% vs. 13%, P 1 0.04). Although 58% of children in the MLr
group did not receive effective antibiotics, all children were discharged without
sequelae. In conclusion, 15% of CAP in children is caused by M. pneumoniae and the
macrolide-resistance rate is 23% in Taiwan. Despite ineffective antibiotics, children
with MLr M. pneumoniae pneumonia recover completely.
Pediatr Pulmonol. 2013; 48:904–911. _ 2012 Wiley Periodicals, Inc.
Key words: children; drug resistance; macrolides; Mycoplasma pneumoniae
pneumonia.
Funding source: National Health Research Institutes, Taiwan.
INTRODUCTION
Mycoplasma pneumoniae (M. pneumoniae) is an important
respiratory pathogen in children that causes
many upper and lower respiratory tract diseases, including
wheezing, coryza, and bronchopneumonia.1 It
accounts for 10–30% of community-acquired pneumonia
(CAP) in children.2,3 Because of the lack of cell
walls, beta-lactam antibiotics are not effective and macrolides
are generally the first choice antibiotics for the
treatment of M. pneumoniae infections. M. pneumoniae
pneumonia is considered a self-limiting disease but
1Department of Pediatrics, Buddhist Tzu Chi General Hospital, Taipei
Branch, Taipei, Taiwan.
2Department of Pediatrics, National Taiwan University Hospital, Taipei,
Taiwan.
3Department of Pediatrics, China Medical University Hospital, Taichung,
Taiwan.
4Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
5Division of Infectious Diseases, Department of Pediatrics, Taoyuan
Chang-Gung Memorial Hospital and Chang-Gung University College of
Medicine, Taoyuan, Taiwan, Taiwan.
6Division of Infectious Diseases, Department of Pediatrics, Kaohsiung
Chang-Gung Memorial Hospital and Chang-Gung University College of
Medicine, Kaohsiung, Taiwan.
7Department of Pediatrics, National Cheng-Kung University Hospital,
Tainan, Taiwan.
Ping-Sheng Wu and Luan-Yin Chang contributed equally to this work.
Conflict of interest: None.
*Correspondence to: Yhu-Chering Huang, MD, PhD, Department of
Pediatrics, Chang-Gung Memorial Hospital, No. 5, Fu-Hsin Street,
Kweishan, Taoyuan 333, Taiwan. E-mail: ychuang@adm.cgmh.org.tw
**Correspondence to: Li-Min Huang, MD, PhD, Department of Pediatrics,
National Taiwan University Hospital, 7, Chung-Shan South Road,
Taipei 100, Taiwan. E-mail: lmhuang@ntu.edu.tw
Received 14 May 2012; Accepted 22 August 2012.
DOI 10.1002/ppul.22706
Published online 20 November 2012 in Wiley Online Library
(wileyonlinelibrary.com).
_ 2012