Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia

M ycoplasma pneumoniae is a common causative pathogen in community-acquired pneumonia (CAP) during childhood.In the post-pneumococcal conjugate vaccine (PCV) 13 era, the epidemiology of pediatric pneumonia has changed.In some countries where PCV13 is already included in national immunization program, M. pneumoniae has become the leading pathogen in pediatric CAP (1,2).The clinical manifestations of M. pneumoniae infection are usually mild and self-limited.However, life-threatening pneumonia or even acute respiratory distress syndrome requiring extracorporeal membrane oxygen has been reported (3).Furthermore, some extrapulmonary symptoms, such as mucositis, hepatitis, encephalitis, hemolysis, or erythema multiforme, have linked M. pneumoniae infection to the formation of autoimmunity or immune complexes.The association between M. pneumoniae and refractory asthma has also been mentioned (4).Macrolides are the first-line therapy for M. pneumoniae.Because of high oral bioavailability and oncedaily formulation, macrolides have been widely used in outpatient settings.During the past 10 years, however, macrolide-resistant Mycoplasma pneumoniae (MRMP) has emerged worldwide.The most prevalent area is Asia, where prevalence rates are 13.6%-100% (5).In Japan and China, resistance rates are >90% in some epidemic years (5,6).The treatment of MRMP has become challenging.Although 1 report showed more complications in managing MRMP infections (7), the association between severe disease and resistance remains inconsistent and unclear.We conducted a systematic review and meta-analysis to examine the effect of macrolide resistance on the manifestations, outcomes, and clinical judgment of M. pneumoniae infection. Methods Search StrategyWe conducted a systematic literature search in PubMed, Embase, and the Cochrane Library database using the keywords Mycoplasma pneumoniae, macrolide, antibiotic resistance, and drug resistance.There was no language restriction in our search.We reviewed eligible full texts and the reference lists of the relevant studies.The last update of the study was on December 1, 2019.Two independent reviewers (Y.-C.C. and T.-H.C.) screened all titles and abstracts for eligibility.Studies were eligible for inclusion if the study population was restricted to children (<18 years of age) with community-acquired pneumonia; macrolide Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia