To investigate the drug resistance of Mycoplasma pneumoniae among children with community-acquired
pneumonia (CAP), and to explore the clinical and radiological characteristics of and the role of
azithromycin in the treatment of of
macrolide-resistant (MR) Mycoplasma pneumoniae
pneumonia.
METHODS: Cases of CAP in children (n = 179) were prospectively enrolled in the Pediatric ward of Beijing Chaoyang Hospital from 1st September, 2010 to 31st August 2011. Pharyngeal swabs were collected for detection of Mycoplasma pneumoniae
DNA. Mycoplasma pneumoniae culture and in vitro susceptibility testing were also performed.
RESULTS: Eighty-three cases met the diagnostic criteria of
mycoplasma pneumonia, accounting for 46% of the CAP patients. Mycoplasma pneumoniae culture was positive in 45 cases, including 44 highly resistant to
macrolides (MR) in vitro, and 1 sensitive. The 44 cases caused by MR pathogen presented with
fever for (8 ± 3) d and
cough for (17 ± 5) d, with higher
fever (39.5 ± 0.7) °C and more irritating dry
cough. In most of the children, peripheral blood leukocytes (8 ± 4)×10(9)/L were normal, with normal or elevated (0.60 ± 0.94) neutrophils, normal or slightly elevated erythrocyte sedimentation rate [(24 ± 14) mm/1 h] and CRP (12.8 mg/L). Chest X-ray showed lobar consolidation in 10 cases (23%, 10/44), among them 3 in the lower left lung, 2 in the left lung, 3 in the right lower lung, 2 in the right upper lung.
Pleural effusion (small amount), combined with right lower lung consolidation, was found in 1 case. Patchy shadows were found in 27 cases, and interstitial lung infiltrate in 7 cases. Of the 44 cases caused by MR Mycoplasma pneumoniae, 19 had lung computed tomography (CT) scanning, among them 13 had lobar or segmental consolidation.
Azithromycin therapy started in an average of 4.0 days after onset of illness, with
duration of therapy averaging (9 ± 4) d.
Cephalosporin or
penicillin (n = 1) was the initial
antibiotic choice in 12 of them, while combination
therapy with
azithromycin and
cephalosporin or
penicillin antibiotics was given in 41 of them. The duration of
fever averaged (6 ± 3) d
after treatment of
azithromycin and duration of
cough averaged (17 ± 5) d
after treatment. Among patients with MR
Mycoplasma pneumonia, those with lobar consolidation had longer duration of
fever after treatment with
azithromycin, compared with those without consolidation (P < 0.05).
CONCLUSIONS: