Macrolide-resistant Mycoplasma pneumoniae in adolescents with community-acquired pneumonia

BMC Infectious Diseases

Niro Okimoto²  Takeyuki Kurihara²  Toshikiyo Hayashi²  Kazunobu Ouchi¹  Hiroto Akaike¹  Yasuhiro Kawai¹  Naoyuki Miyashita² 

[1] Department of Pediatrics, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan;Department of Internal Medicine I, Kawasaki Medical School, 2-1-80 Nakasange, Kita-ku, Okayama, 700-8505, Japan

关键词: 23S rRNA;    Community-acquired pneumonia;    Macrolide-resistant;    Mycoplasma pneumoniae;   

Others  :  1175365
DOI  :  10.1186/1471-2334-12-126

 received in 2011-12-19, accepted in 2012-05-31,  发布年份 2012

【 摘 要 】

Background

Although the prevalence of macrolide-resistant Mycoplasma pneumoniae isolates in Japanese pediatric patients has increased rapidly, there have been no reports concerning macrolide-resistant M. pneumoniae infection in adolescents aged 16 to 19 years old. The purpose of this study was to clarify the prevalence and clinical characteristics of macrolide-resistant M. pneumoniae in adolescent patients with community-acquired pneumonia.

Methods

A total of 99 cases with M. pneumoniae pneumonia confirmed by polymerase chain reaction (PCR) and culture were analyzed. Forty-five cases were pediatric patients less than 16 years old, 26 cases were 16 to 19-year-old adolescent patients and 28 cases were adult patients. Primers for domain V of 23S rRNA were used and DNA sequences of the PCR products were compared with the sequence of an M. pneumoniae reference strain.

Results

Thirty of 45 pediatric patients (66%), 12 of 26 adolescent patients (46%) and seven of 28 adult patients (25%) with M. pneumoniae pneumonia were found to be infected with macrolide-resistant M. pneumoniae (MR patients). Although the prevalence of resistant strains was similar in pediatric patients between 2008 and 2011, an increase in the prevalence of resistant strains was observed in adolescent patients. Among 30 pediatric MR patients, 26 had an A-to-G transition at position 2063 (A2063G) and four had an A-to-G transition at position 2064 (A2064G). In 12 adolescent MR patients, 10 showed an A2063G transition and two showed an A2064G transition, and in seven adult MR patients, six showed an A2063G transition and one showed an A2064G transition.

Conclusions

The prevalence of macrolide-resistant M. pneumoniae is high among adolescent patients as well as pediatric patients less than 16-years old. To prevent outbreaks of M. pneumoniae infection, especially macrolide-resistant M. pneumoniae, in closed populations including among families, in schools and in university students, physicians should pay close attention to macrolide-resistant M. pneumoniae.

【 授权许可】

   
2012 Miyashita et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]The committee for the Japanese Respiratory Society guidelines in management of respiratory infections: The Japanese Respiratory Society guideline for the management of community-acquired pneumonia in adults. Respirology 2006, 11(Suppl 3):79-133.
• [2]National Institute of Health: [http://idsc.nih.go.jp/idwr/kanja/weeklygraph/18myco.html] webciteInfectious Disease Surveillance Center. Mycoplasma pneumoniae pneumonia. 2000.
• [3]Rasmussen JN, Voldstedlund M, Andersen RL, Ellermann-Eriksen S, Jensen TG, Johansen HK, Kolmos B, Molvadgaard M, Nielsen SS, Olsen E, Schonning K, Uldum SA: Increased incidence ofMycoplasma pneumoniaeinfections detected by laboratory-based surveillance in Denmark in 2010. Euro Surveill 2010, 15:45.
• [4]Chalker V, Stocki T, Mentasti M, Fleming D, Harrison T: Increased incidence ofMycoplasma pneumoniaeinfection in England and Wales in 2010: multiocus variable number tandem repeat analysis typing and macrolide susceptibility. Euro Surveill 2011, 16:19.
• [5]Averbuch D, Hidalgo-Grass C, Moses AE, Engelhard D, Nir-Paz R: Macrolide resistance inMycoplasma pneumoniae,Israel, 2010. Emerg Infect Dis 2011, 17(6):1079-1082.
• [6]Polkowska A, Harjunpää A, Toikkanen S, Lappalainen M, Vuento R, Vuorinen T, Kauppinen J, Flinck H, Lyytikäinen O: Increased incidence of Mycoplasma pneumoniae infection in Finland, 2010–2011. Euro Surveill 2012., 17(5)
• [7]Blystad H, Ånestad G, Vestrheim DF, Madsen S, Rønning K: Increased incidence of Mycoplasma pneumoniae infection in Norway 2011. Euro Surveill 2012., 17(5)
• [8]Uldum SA, Bangsborg JM, Gahrn-Hansen B, Ljung R, Mølvadgaard M, Føns Petersen R, Wiid Svarrer C: Epidemic of Mycoplasma pneumoniae infection in Denmark, 2010 and 2011. Euro Surveill 2012., 17(5)
• [9]Chalker VJ, Stocki T, Litt D, Bermingham A, Watson J, Fleming DM, Harrison TG: Increased detection ofMycoplasma pneumoniaeinfection in children in England and Wales, October 2011 to January 2012. Euro Surveill 2012, 17:6.
• [10]Linde A, Ternhag A, Törner A, Claesson BE: Antibiotic prescriptions and laboratory-confirmed cases ofMycoplasma pneumoniaeduring the epidemic in Sweden in 2011. Euro Surveill 2012, 17:6.
• [11]Eibach D, Escuret V, Billaud G, Mekki Y, Frobert E, Bouscambert-Duchamp M, Lina B, Morfin F: Increased detection ofMycoplasma pneumoniaeinfection in children, Lyon, France, 2010 to 2011. Euro Surveill 2012, 17:8.
• [12]Matsuoka M, Narita M, Okazaki N, Ohya H, Yamazaki T, Ouchi K, Suzuki I, Andoh T, Kenri T, Sasaki Y, Horino A, Shintani M, Arakawa Y, Sasaki T: Characterization and molecular analysis of macrolide-resistantMycoplasma pneumoniaeclinical isolates obtained in Japan. Antimicrob Agents Chemother 2004, 48(12):4624-4630.
• [13]Okazaki N, Narita M, Yamada S, Izumikawa K, Umetsu M, Kenri T, Sasaki Y, Arakawa Y, Sasaki T: Characteristics of macrolide-resistantMycoplasma pneumoniaestrains isolated from patients and induced with erythromycin in vitro. Microbiol Immunol 2001, 45(8):617-620.
• [14]Morozumi M, Takahashi T, Ubukata K: Macrolide-resistantMycoplasma pneumoniae: characteristics of isolates and clinical aspects of community-acquired pneumonia. J Infect Chemother 2010, 16(2):78-86.
• [15]Miyashita N, Kawai Y, Yamaguchi T, Ouchi K, Oka M, Atypical Pathogen Study Group: Macrolide-resistant Mycoplasma pneumoniae in adults with community-acquired pneumonia. Int J Antimicrob Agents 2010, 36(4):384-385.
• [16]Suzuki S, Yamazaki T, Narita M, Okazaki N, Suzuki I, Andoh T, Matsuoka M, Kenri T, Arakawa Y, Sasaki T: Clinical evaluation of macrolide-resistantMycoplasma pneumoniae. Antimicrob Agents Chemother 2006, 50(2):709-712.
• [17]Matsubara K, Morozumi M, Okada T, Matsushima T, Komiyama O, Shoji M, Ebihara T, Ubukata K, Sato Y, Akita H, Sunakawa K, Iwata S: A comparative clinical study of macrolide-sensitive and macrolide-resistantMycoplasma pneumoniaeinfections in pediatric patients. J Infect Chemother 2009, 15(6):380-383.
• [18]Kawai Y, Miyashita N, Yamaguchi T, Saitoh A, Kondoh E, Fujimoto H, Teranishi H, Inoue M, Wakabayashi T, Akaike H, Ogita S, Kawasaki K, Terada K, Kishi F, Ouchi K: Clinical efficacy of macrolide antibiotics against genetically determined macrolide-resistantMycoplasma pneumoniaepneumonia in pediatric patients. Respirology 2012, 17(2):354-362.
• [19]Miyashita N, Kawai Y, Yamaguchi T, Ouchi K, Oka M, Atypical Pathogen Study Group: Clinical potential of diagnostic methods for the rapid diagnosis of Mycoplasma pneumoniae pneumonia in adults. Eur J Clin Microbiol Infect Dis 2011, 30(3):439-446.
• [20]Lucier TS, Heitzman K, Liu SK, Hu PC: Transition mutations in the 23 S rRNA of erythromycin-resistant isolates ofMycoplasma pneumoniae. Antimicrob Agents Chemother 1995, 39(12):2770-2773.
• [21]Isozumi R, Yoshimine H, Morozumi M, Ubukata K, Ariyoshi K: Adult community-acquired pneumonia caused by macrolide resistantMycoplasma pneumoniae. Respirology 2009, 14(8):1206-1208.
• [22]Peuchant O, Menard A, Renaudin H, Morozumi M, Ubukata K, Bebear CM, Pereyre S: Increased macrolide resistance ofMycoplasma pneumoniae in France directly detected in clinical specimens by real-time PCR and melting curve analysis. J Antimicrob Chemother 2009, 64(1):52-58.
• [23]Wolff BJ, Thacker WL, Schwartz SB, Winchell JM: Detection of macrolide resistance inMycoplasma pneumoniaeby real-time PCR and high-resolution melt analysis. Antimicrob Agents Chemother 2008, 52(10):3542-3549.
• [24]Dumke R, von Baum H, Luck PC, Jacobs E: Occurrence of macrolide-resistantMycoplasma pneumoniaestrain in Germany. Clin Microbial Infect 2010, 16(6):613-616.
• [25]Chironna M, Sallustio A, Esposito S, Perulli M, Chinellato I, Di Bari C, Quarto M, Cardinale F: Emergence of macrolide-resistant strains during an outbreak ofMycoplasma pneumoniaeinfections in children. J Antimicrob Chemother 2011, 66(4):734-737.
• [26]Cao B, Zhao CJ, Yin YD, Zhao F, Song SF, Bai L, Zhang JZ, Liu YM, Zhang YY, Wang H, Wang C: High prevalence of macrolide resistance inMycoplasma pneumoniaeisolates from adult and adolescent patients with respiratory tract infection in China. Clin Infect Dis 2010, 51(2):189-194.