Epidemiology and mechanism of drug resistance of Mycoplasma pneumoniae in Beijing, China: A multi-center study.

Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired respiratory tract infections (RTIs). We aimed to investigate the prevalence of M. pneumoniae infection, antibiotic resistance and genetic diversity of M. pneumoniae isolates across multiple centers in Beijing, China. P1 protein was detected by Nested PCR to analyze the occurrence of M. pneumoniae in pediatric patients with RTI. M. pneumoniae isolates were cultured and analyzed by Nested-PCR to determine their genotypes. Broth microdilution method was used to determine the minimum inhibitory concentration (MIC) of antibiotics. Out of 822 children with RTI admitted to 11 hospitals in Beijing, 341 (41.48%) were positive for M. pneumoniae by Nested PCR and 236 (69.21%) samples had mutations in 23S rRNA domain V. The highest proportion of M. pneumoniae positive samples was observed in school-age children (118/190; 62.11%) and in pediatric patients with pneumonia (220/389; 56.56%). Out of 341 M. pneumoniae positive samples, 99 (12.04%) isolates were successfully cultured and the MIC values were determined for 65 M. pneumoniae strains. Out of these, 57 (87.69%) strains were resistant to macrolides, and all 65 strains were sensitive to tetracyclines or quinolones. M. pneumoniae P1 type I and P1 type II strains were found in 57/65 (87.69%) and 8/65 (12.31%) of cultured isolates, respectively. Overall, we demonstrated a high prevalence of M. pneumoniae infection and high macrolide resistance of M. pneumoniae strains in Beijing. School-age children were more susceptible to M. pneumoniae, particularly the children with pneumonia. Thus, establishment of a systematic surveillance program to fully understand the epidemiology of M. pneumoniae is critical for the standardized use of antibiotics in China.

[1]  S. Venkatram,et al.  Mycoplasma pneumoniae: A Potentially Severe Infection , 2018, Journal of clinical medicine research.

[2]  Surinder Kumar.  Mycoplasma pneumoniae: A significant but underrated pathogen in paediatric community-acquired lower respiratory tract infections , 2018, The Indian journal of medical research.

[3]  T. Ariga,et al.  Regional Differences in Prevalence of Macrolide Resistance among Pediatric Mycoplasma pneumoniae Infections in Hokkaido, Japan. , 2016, Japanese journal of infectious diseases.

[4]  Sung-Churl Lee,et al.  Early Serologic Diagnosis of Mycoplasma pneumoniae Pneumonia: An Observational Study on Changes in Titers of Specific-IgM Antibodies and Cold Agglutinins , 2016, Medicine.

[5]  D. Keše,et al.  Prevalence, genotyping and macrolide resistance of Mycoplasma pneumoniae among isolates of patients with respiratory tract infections, Central Slovenia, 2006 to 2014. , 2015, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[6]  Zhengrong Chen,et al.  Epidemiology and clinical profiles of Mycoplasma pneumoniae infection in hospitalized infants younger than one year. , 2015, Respiratory medicine.

[7]  Eun-kyung Kim,et al.  Epidemiological comparison of three Mycoplasma pneumoniae pneumonia epidemics in a single hospital over 10 years , 2015, Korean journal of pediatrics.

[8]  Xiang-zhi Li,et al.  Macrolide-Resistant Mycoplasma pneumoniae in Adults in Zhejiang, China , 2014, Antimicrobial Agents and Chemotherapy.

[9]  Maureen H Diaz,et al.  Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013 , 2014, Journal of Clinical Microbiology.

[10]  C. Vink,et al.  Mycoplasma pneumoniae in children: carriage, pathogenesis, and antibiotic resistance , 2014, Current opinion in infectious diseases.

[11]  Ling Cao,et al.  Surveillance of Mycoplasma pneumoniae infection among children in Beijing from 2007 to 2012 , 2014, Chinese medical journal.

[12]  Deli Xin,et al.  Drug Resistance Mechanisms of Mycoplasma pneumoniae to Macrolide Antibiotics , 2014, BioMed research international.

[13]  Dan Li,et al.  P1 gene of Mycoplasma pneumoniae in clinical isolates collected in Beijing in 2010 and relationship between genotyping and macrolide resistance , 2013, Chinese medical journal.

[14]  Shi-Jie Jin,et al.  [Mycoplasma pneumoniae infection and drug resistance in children: an analysis of 1026 cases]. , 2013, Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics.

[15]  Y. Nishizawa,et al.  Nationwide Surveillance of Macrolide-Resistant Mycoplasma pneumoniae Infection in Pediatric Patients , 2013, Antimicrobial Agents and Chemotherapy.

[16]  Jiang Wu,et al.  Surveillance of Macrolide-Resistant Mycoplasma pneumoniae in Beijing, China, from 2008 to 2012 , 2012, Antimicrobial Agents and Chemotherapy.

[17]  Jiang Wu,et al.  Multiple-Locus Variable-Number Tandem-Repeat Analysis of 201 Mycoplasma pneumoniae Isolates from Beijing, China, from 2008 to 2011 , 2012, Journal of Clinical Microbiology.

[18]  R. Ljung,et al.  Epidemic of Mycoplasma pneumoniae infection in Denmark, 2010 and 2011. , 2012, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[19]  X. Tao,et al.  Antibiotic Sensitivity of 40 Mycoplasma pneumoniae Isolates and Molecular Analysis of Macrolide-Resistant Isolates from Beijing, China , 2011, Antimicrobial Agents and Chemotherapy.

[20]  M. Sluijter,et al.  Macrolide resistance determination and molecular typing of Mycoplasma pneumoniae by pyrosequencing. , 2010, Journal of microbiological methods.

[21]  M. Morozumi,et al.  Increased macrolide resistance of Mycoplasma pneumoniae in France directly detected in clinical specimens by real-time PCR and melting curve analysis. , 2009, The Journal of antimicrobial chemotherapy.

[22]  Deli Xin,et al.  Molecular Mechanisms of Macrolide Resistance in Clinical Isolates of Mycoplasma pneumoniae from China , 2009, Antimicrobial Agents and Chemotherapy.

[23]  Hong Zhang,et al.  Antimicrobial Susceptibility of Mycoplasma pneumoniae Isolates and Molecular Analysis of Macrolide-Resistant Strains from Shanghai, China , 2009, Antimicrobial Agents and Chemotherapy.

[24]  Mitchell F. Balish,et al.  Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infections. , 2008, FEMS microbiology reviews.

[25]  S. Pereyre,et al.  First Report of Macrolide-Resistant Strains and Description of a Novel Nucleotide Sequence Variation in the P1 Adhesin Gene in Mycoplasma pneumoniae Clinical Strains Isolated in France over 12 Years , 2007, Journal of Clinical Microbiology.

[26]  H. Ohya,et al.  Characterization and Molecular Analysis of Macrolide-Resistant Mycoplasma pneumoniae Clinical Isolates Obtained in Japan , 2004, Antimicrobial Agents and Chemotherapy.

[27]  Ken B. Waites,et al.  Mycoplasma pneumoniae and Its Role as a Human Pathogen , 2004, Clinical Microbiology Reviews.

[28]  S. Pereyre,et al.  In Vitro Selection and Characterization of Resistance to Macrolides and Related Antibiotics in Mycoplasma pneumoniae , 2004, Antimicrobial Agents and Chemotherapy.

[29]  Diane E. Taylor,et al.  Mutations in the 16S rRNA Genes of Helicobacter pylori Mediate Resistance to Tetracycline , 2002, Journal of bacteriology.

[30]  H. Moll,et al.  Respiratory tract infections by Mycoplasma pneumoniae in children: a review of diagnostic and therapeutic measures , 2001, European Journal of Pediatrics.

[31]  F. Blasi,et al.  Role of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community-acquired lower respiratory tract infections. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[32]  J. W. Dorigo-Zetsma,et al.  Genotyping of Mycoplasma pneumoniaeClinical Isolates Reveals Eight P1 Subtypes within Two Genomic Groups , 2000, Journal of Clinical Microbiology.

[33]  T. Marrie,et al.  Mycoplasma pneumoniae pneumonia requiring hospitalization, with emphasis on infection in the elderly. , 1993, Archives of internal medicine.

[34]  M. Sillis.  Mycoplasma pneumoniae , 1991, The Lancet.

[35]  S. Mitchell,et al.  Detection of Mycoplasma pneumoniae by real-time PCR. , 2013, Methods in molecular biology.

[36]  D. Fleming,et al.  Increased incidence of Mycoplasma pneumoniae infection in England and Wales in 2010 : multiocus variable number tandem repeat analysis typing and macrolide susceptibility , 2011 .

[37]  P. Wayne.  Clinical and Laboratory Standards Institute : Performance standards for antimicrobial susceptibility testing : 20th informational supplement , 2010 .

[38]  M. Hammami,et al.  Amplification of P1 and 16S rRNA genes by nested PCR for detection of Mycoplasma pneumoniae in paediatric patients. , 2005, Pathologie-biologie.

[39]  M. Korppi.  Community-acquired pneumonia in children: issues in optimizing antibacterial treatment. , 2003, Paediatric drugs.

[40]  R. Khakoo,et al.  Mycoplasma pneumoniae infections. , 1981, The West Virginia medical journal.