Clinical characteristics of macrolide-resistant Mycoplasma pneumoniae infections among hospitalised children in Singapore (original) (raw)
2022, Annals Academy of Medicine Singapore
Clinical characteristics of macrolide-resistant Mycoplasma pneumoniae infections among hospitalised children in Singapore LETTER TO THE EDITOR Dear Editor, Mycoplasma pneumoniae has become the leading cause of paediatric community-acquired pneumonia in countries where pneumococcal vaccination is included in the national immunisation programme, including Singapore. 1 M. pneumoniae is intrinsically resistant to beta-lactams due to the absence of cell walls. Macrolides, tetracyclines, and fluoroquinolones are used to treat M. pneumoniae infections, and macrolides are recommended in children, due to the potential adverse effects of tetracyclines and fluoroquinolones. Macrolideresistant M. pneumoniae (MRMP) isolates were first observed in 2001. 2 The prevalence of MRMP worldwide varies from 0.2% in Europe to 90% in East Asia. 3 In Singapore, the prevalence of MRMP in hospitalised children was 13% in 2017. 4 Studies in Asia have reported increased disease severity in persons infected with MRMP, 5 while others have not detected differences in the clinical course in persons with MRMP versus those with macrolide-susceptible M. pneumoniae (MSMP) infections. 6 We compare differences between hospitalised children with MSMP and those with MRMP infections. From July 2019 to February 2020, patients younger than 16 years in KK Women's and Children's Hospital, Singapore, who tested positive for M. pneumoniae by polymerase chain reaction on nasopharyngeal or throat swab samples, were screened for inclusion. Assessment of genotypic macrolide resistance was done as previously described. 4 Sequencing was performed retrospectively; thus, the results of genotypic macrolide resistance were not known at the time of treatment. Electronic medical records of patients with M. pneumoniae infection were retrospectively reviewed after informed consent was obtained. Demographic and clinical data were collected and matched to the results of genotypic macrolideresistance testing. Comparisons between binary groups were analysed using chi-square or Fisher's Exact test for categorical variables, and Mann-Whitney U test for continuous variables. All P values were two-tailed and differences were considered statistically significant at <0.05. Between July 2019 and February 2020, 170 patients with M. pneumoniae infection consented to participate in this study. Thirty-one patients (18.2%) had
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