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Background <p><i>Mycoplasma pneumoniae</i> (MP) is a major cause of pediatric respiratory tract infections (RTIs), with recent increases in incidence and macrolide resistance. The epidemiology of MP, macrolide-resistant MP (MRMP), co-infection patterns, and their relationship with disease severity in the post-COVID era remain poorly understood. We analyzed temporal trends in MP infection and MRMP prevalence and assessed their association with severe community-acquired pneumonia (SCAP).</p> Methods <p>Children aged &lt; 18 years hospitalized with RTIs at Beijing Children’s Hospital were retrospectively enrolled during 2018–2024. Respiratory samples were tested for MP and macrolide resistance mutations. Data on co-infecting bacterial and viral pathogens were collected in clinical practice and retrospectively included in this study. We analyzed temporal trends and risk factors for SCAP.</p> Results <p>Among 8,453 children, MP-positive patients accounted for 39.7%, declining to 17.0% in 2021 and rising sharply to 62.8% in 2024. The highest MP-positivity rates were seen in children aged 5–9 years, although a notable increase occurred in children aged &lt; 5 years in 2024. MRMP was detected in 96.9% of MP-positive cases, with resistance rates &gt; 95% from 2022. After 2021, co-infections were detected in 19.9% of cases tested for bacterial and viral pathogens, most commonly involving human rhinovirus–MP, <i>Haemophilus influenzae</i>–MP, and <i>Streptococcus pneumoniae</i>–MP. Risk factors for SCAP included female sex, age &gt; 5 years, cold season onset, pure MP infection, and MP co-infection. MRMP was not an independent predictor of SCAP.</p> Conclusions <p>The burden of MP infection has resurged post-COVID, with sustained high macrolide resistance and evolving co-infection patterns. Our findings underscore the importance of ongoing surveillance and tailored management strategies for pediatric MP infections.</p>

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Etiological characteristics of Mycoplasma pneumoniae infection and macrolide resistance in children in beijing: a retrospective study from 2018 to 2024

  • 期刊论文

  • 发表日期：

    2025年8月27日

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  • Wanning Chen,
  • Hui Qi,
  • Weiwei Jiao,
  • Yajie Guo,
  • Yuqing Wang,
  • Jinrong Liu,
  • Baoping Xu,
  • Chengsong Zhao,
  • Lin Sun

摘要

Background

Mycoplasma pneumoniae (MP) is a major cause of pediatric respiratory tract infections (RTIs), with recent increases in incidence and macrolide resistance. The epidemiology of MP, macrolide-resistant MP (MRMP), co-infection patterns, and their relationship with disease severity in the post-COVID era remain poorly understood. We analyzed temporal trends in MP infection and MRMP prevalence and assessed their association with severe community-acquired pneumonia (SCAP).

Methods

Children aged < 18 years hospitalized with RTIs at Beijing Children’s Hospital were retrospectively enrolled during 2018–2024. Respiratory samples were tested for MP and macrolide resistance mutations. Data on co-infecting bacterial and viral pathogens were collected in clinical practice and retrospectively included in this study. We analyzed temporal trends and risk factors for SCAP.

Results

Among 8,453 children, MP-positive patients accounted for 39.7%, declining to 17.0% in 2021 and rising sharply to 62.8% in 2024. The highest MP-positivity rates were seen in children aged 5–9 years, although a notable increase occurred in children aged < 5 years in 2024. MRMP was detected in 96.9% of MP-positive cases, with resistance rates > 95% from 2022. After 2021, co-infections were detected in 19.9% of cases tested for bacterial and viral pathogens, most commonly involving human rhinovirus–MP, Haemophilus influenzae–MP, and Streptococcus pneumoniae–MP. Risk factors for SCAP included female sex, age > 5 years, cold season onset, pure MP infection, and MP co-infection. MRMP was not an independent predictor of SCAP.

Conclusions

The burden of MP infection has resurged post-COVID, with sustained high macrolide resistance and evolving co-infection patterns. Our findings underscore the importance of ongoing surveillance and tailored management strategies for pediatric MP infections.