Abstract：
BACKGROUND: Mycoplasma pneumoniae (M. pneumoniae) is a significant contributor to community-acquired pneumonia among children. Since 1968, when a strain of M. pneumoniae resistant to macrolide antibiotics was initially reported in Japan, macrolide-resistant M. pneumoniae (MRMP) has been documented in many countries worldwide, with varying incidence rates. MRMP infections lead to a poor response to macrolide antibiotics, frequently resulting in prolonged fever, extended antibiotic treatment, increased hospitalization, intensive care unit admissions, and a significantly higher proportion of patients receiving glucocorticoids or second-line antibiotics. Since 2000, the global incidence of MRMP has gradually increased, especially in East Asia, which has posed a serious challenge to the treatment of M. pneumoniae infections in children and attracted widespread attention from pediatricians. However, there is still no global consensus on the diagnosis and treatment of MRMP in children.
METHODS: We organized 29 Chinese experts majoring in pediatric pulmonology and epidemiology to write the world\'s first consensus on the diagnosis and treatment of pediatric MRMP pneumonia, based on evidence collection. The evidence searches and reviews were conducted using electronic databases, including PubMed, Embase, Web of Science, CNKI, Medline, and the Cochrane Library. We used variations in terms for \"macrolide-resistant\", \"Mycoplasma pneumoniae\", \"MP\", \"M. pneumoniae\", \"pneumonia\", \"MRMP\", \"lower respiratory tract infection\", \"Mycoplasma pneumoniae infection\", \"children\", and \"pediatric\".
RESULTS: Epidemiology, pathogenesis, clinical manifestations, early identification, laboratory examination, principles of antibiotic use, application of glucocorticoids and intravenous immunoglobulin, and precautions for bronchoscopy are highlighted. Early and rapid identification of gene mutations associated with MRMP is now available by polymerase chain reaction and fluorescent probe techniques in respiratory specimens. Although the resistance rate to macrolide remains high, it is fortunate that M. pneumoniae still maintains good in vitro sensitivity to second-line antibiotics such as tetracyclines and quinolones, making them an effective treatment option for patients with initial treatment failure caused by macrolide antibiotics.
CONCLUSIONS: This consensus, based on international and national scientific evidence, provides scientific guidance for the diagnosis and treatment of MRMP in children. Further studies on tetracycline and quinolone drugs in children are urgently needed to evaluate their effects on the growth and development. Additionally, developing an antibiotic rotation treatment strategy is necessary to reduce the prevalence of MRMP strains.
METHODS: We organized 29 Chinese experts majoring in pediatric pulmonology and epidemiology to write the world\'s first consensus on the diagnosis and treatment of pediatric MRMP pneumonia, based on evidence collection. The evidence searches and reviews were conducted using electronic databases, including PubMed, Embase, Web of Science, CNKI, Medline, and the Cochrane Library. We used variations in terms for \"macrolide-resistant\", \"Mycoplasma pneumoniae\", \"MP\", \"M. pneumoniae\", \"pneumonia\", \"MRMP\", \"lower respiratory tract infection\", \"Mycoplasma pneumoniae infection\", \"children\", and \"pediatric\".
RESULTS: Epidemiology, pathogenesis, clinical manifestations, early identification, laboratory examination, principles of antibiotic use, application of glucocorticoids and intravenous immunoglobulin, and precautions for bronchoscopy are highlighted. Early and rapid identification of gene mutations associated with MRMP is now available by polymerase chain reaction and fluorescent probe techniques in respiratory specimens. Although the resistance rate to macrolide remains high, it is fortunate that M. pneumoniae still maintains good in vitro sensitivity to second-line antibiotics such as tetracyclines and quinolones, making them an effective treatment option for patients with initial treatment failure caused by macrolide antibiotics.
CONCLUSIONS: This consensus, based on international and national scientific evidence, provides scientific guidance for the diagnosis and treatment of MRMP in children. Further studies on tetracycline and quinolone drugs in children are urgently needed to evaluate their effects on the growth and development. Additionally, developing an antibiotic rotation treatment strategy is necessary to reduce the prevalence of MRMP strains.
摘要：
背景：肺炎支原体（M.肺炎）是儿童社区获得性肺炎的重要原因。自1968年以来，日本最初报道了对大环内酯类抗生素耐药的肺炎支原体菌株，大环内酯耐药肺炎支原体（MRMP）已在世界许多国家被证明，发病率不同。MRMP感染导致对大环内酯类抗生素的反应不佳，经常导致长时间的发烧，延长抗生素治疗，住院率增加，重症监护室入院，接受糖皮质激素或二线抗生素的患者比例明显更高。自2000年以来，MRMP的全球发病率逐渐上升，尤其是在东亚，对儿童肺炎支原体感染的治疗提出了严峻的挑战,引起了儿科医生的广泛关注。然而,关于儿童MRMP的诊断和治疗仍未达成全球共识.
方法：我们组织了29名中国儿科肺病学和流行病学专家，撰写了世界上第一个关于小儿MRMP肺炎诊断和治疗的共识，基于证据收集。使用电子数据库进行证据搜索和审查，包括PubMed,Embase,WebofScience,CNKI,Medline,还有Cochrane图书馆.我们在术语“大环内酯抗性”中使用了变体，“肺炎支原体”，\"MP\",\"M.肺炎\“，\"肺炎\",\"MRMP\",“下呼吸道感染”，“肺炎支原体感染”，\"children\",和“儿科”。
结果：流行病学，发病机制，临床表现，早期识别,实验室检查,抗生素使用原则，糖皮质激素和静脉注射免疫球蛋白的应用，并强调支气管镜检查的注意事项。现在，通过呼吸道标本中的聚合酶链反应和荧光探针技术，可以早期快速鉴定与MRMP相关的基因突变。尽管对大环内酯的耐药率仍然很高，幸运的是，肺炎支原体仍然对四环素和喹诺酮类药物等二线抗生素保持良好的体外敏感性，使它们成为由大环内酯类抗生素引起的初始治疗失败的患者的有效治疗选择。
结论：这一共识，基于国际和国家科学证据，为儿童MRMP的诊断和治疗提供科学指导。迫切需要对儿童四环素和喹诺酮类药物进行进一步研究，以评估其对生长发育的影响。此外,制定抗生素轮换治疗策略对于降低MRMP菌株的患病率是必要的.
方法：我们组织了29名中国儿科肺病学和流行病学专家，撰写了世界上第一个关于小儿MRMP肺炎诊断和治疗的共识，基于证据收集。使用电子数据库进行证据搜索和审查，包括PubMed,Embase,WebofScience,CNKI,Medline,还有Cochrane图书馆.我们在术语“大环内酯抗性”中使用了变体，“肺炎支原体”，\"MP\",\"M.肺炎\“，\"肺炎\",\"MRMP\",“下呼吸道感染”，“肺炎支原体感染”，\"children\",和“儿科”。
结果：流行病学，发病机制，临床表现，早期识别,实验室检查,抗生素使用原则，糖皮质激素和静脉注射免疫球蛋白的应用，并强调支气管镜检查的注意事项。现在，通过呼吸道标本中的聚合酶链反应和荧光探针技术，可以早期快速鉴定与MRMP相关的基因突变。尽管对大环内酯的耐药率仍然很高，幸运的是，肺炎支原体仍然对四环素和喹诺酮类药物等二线抗生素保持良好的体外敏感性，使它们成为由大环内酯类抗生素引起的初始治疗失败的患者的有效治疗选择。
结论：这一共识，基于国际和国家科学证据，为儿童MRMP的诊断和治疗提供科学指导。迫切需要对儿童四环素和喹诺酮类药物进行进一步研究，以评估其对生长发育的影响。此外,制定抗生素轮换治疗策略对于降低MRMP菌株的患病率是必要的.
