Characterizing the epidemiology of <i>Mycoplasma pneumoniae</i> infections in China in 2022–2024: a nationwide cross-sectional study of over 1.6 million cases

<i>Mycoplasma pneumoniae</i> (MP) is a leading cause of community-acquired pneumonia (CAP), accounting for 10-40% of cases in children. In China, the high prevalence of macrolide-resistant MP (MRMP) and recurrent MP epidemics place a significant burden on the healthcare system. Leveraging data from over 1.6 million cases, this study provides a comprehensive analysis of the epidemiological characteristics of MP across China. Seasonal patterns analysis revealed three distinct transmission zones in China. Transmission Zone 1 exhibited two annual epidemic peaks, while Zones 2 and 3 showed a single annual peak of distinct timings. Notably, winter travel to popular tourist destinations appears to influence MP infection patterns in China. Age- and sex- specific analysis indicated male newborns aged [0-1) years face a 1.67 times higher risk of MP infection compared to females. Conversely, females aged [23-38) years have a higher infection risk, likely due to their caregiving roles. The proportion of MRMP surged from 80.00% to 93.02% between July 2023 and May 2024, with a median growth rate of 10.21%. This rapid increase contrasts sharply with the modest 5.3% rise observed from 2011 to 2019, and we attribute this escalation in part to the growing prevalence of the T1-3R clade strain in China. These findings have important implications for the identification of high-risk population, place, and time for more targeted efforts of prevention and treatment. Furthermore, the rapidly increased proportion of MRMP in the 2023-2024 season raises a concerning signal regarding antibiotic use.