Abstract
BACKGROUND: The rising global prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) poses a significant challenge in managing Mycoplasma pneumoniae pneumonia (MPP) in children, particularly in China. Understanding the clinical impact of MRMP and identifying early predictors for progression to refractory MPP (RMPP) are crucial for optimizing treatment and resource allocation. This study aimed to characterize the clinical features and outcomes of MRMP infection and develop a predictive model for RMPP progression. METHODS: In this single-center, retrospective cohort study, 175 pediatric patients hospitalized with MPP between February 2023 and May 2024 were enrolled. Patients were divided into an MRMP group (n=95) and a non-MRMP group (n=80) based on 23S rRNA gene mutations detected in Mycoplasma pneumoniae from bronchoalveolar lavage fluid (BALF). The MRMP group was further subdivided into RMPP (n=30) and non-RMPP (n=65) based on clinical criteria. Demographic, clinical, laboratory, radiological, and bronchoscopic data were compared. Receiver operating characteristic (ROC) curves and multivariate logistic regression analysis were used to identify risk factors for RMPP progression. RESULTS: The prevalence of MRMP was 54.3% (95/175), with all strains carrying the A2063G mutation. Compared to the non-MRMP group, MRMP patients had significantly higher rates of lung consolidation (74.7% vs. 42.5%, P<0.001), atelectasis (26.3% vs. 12.5%, P=0.02), extrapulmonary complications (47.4% vs. 32.5%, P=0.046), and progression to RMPP (31.6% vs. 11.3%, P=0.001). Within the MRMP group, RMPP patients were older and had more severe clinical and radiological manifestations. Multivariate logistic regression analysis identified fever duration >6.50 days [odds ratio (OR) =12.342, 95% confidence interval (CI): 3.002-50.744, P<0.001], D-dimer >0.54 µg/mL (OR =5.537, 95% CI: 1.215-25.245, P=0.03), and the presence of mucus plugs (OR =4.586, 95% CI: 1.094-19.231, P=0.04) as independent risk factors for RMPP. A prediction model incorporating these factors achieved an area under the curve (AUC) of 0.918 (95% CI: 0.863-0.973, P<0.001). CONCLUSIONS: MRMP infection in children is associated with more severe pulmonary and extrapulmonary manifestations and a higher risk of progressing to RMPP. The developed prediction model, utilizing easily obtainable clinical parameters, demonstrates high diagnostic accuracy for early identification of RMPP risk, potentially facilitating timely intervention and improving patient outcomes.