Macrolide-resistant Mycoplasma pneumoniae pneumonia in Chinese children: a retrospective study of clinical features and prognosis

This study systematically investigated the clinical features, imaging findings, and treatment outcomes associated with macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP) in children, aiming to support early clinical intervention and prevent disease progression. Clinical data from 346 children with Mycoplasma pneumoniae pneumonia (MPP) who underwent bronchoscopic treatment between May 2023 and April 2024 were retrospectively analyzed. Patients were stratified into a macrolide-resistant group (MRG) (n = 281) and a macrolide-sensitive group (MSG) (n = 65). Comparative analyses included demographics, clinical symptoms, laboratory findings, treatment protocols, bronchoscopic findings, pathogen load, and prognoses. Among the 346 cases of MPP, 81.2% (281/346) were classified as MRMPP. Resistant strains predominated in autumn and winter (P < 0.05), with no significant differences in sex, age, or body mass index between groups (P > 0.05). The MRG showed significantly longer durations of fever, cough, abnormal lung sounds, macrolide and glucocorticoid use, and hospital stay and incurred higher hospitalization costs (all P < 0.05). Rates of oxygen therapy, ≥ 2 bronchoscopic interventions, second-line antibiotic use, and extrapulmonary complications were also higher in the MRG, while co-infections were more common in the MSG (P < 0.05). The MRG exhibited elevated neutrophil percentages and C-reactive protein, lactate dehydrogenase, and D-dimer levels (all P < 0.05). Pulmonary consolidation and bronchoscopic mucus plugs were more frequent in the MRG, while thin white secretions were typical of the MSG (P < 0.05). No significant difference in adverse prognosis was observed between groups (6.8% vs. 3.0%, P = 0.74). Multivariate logistic regression and receiver operating characteristic curve analyses identified mucus plug formation (odds ratio = 35.619, P = 0.001) and fever duration of > 6.5 days (area under the curve = 0.794, P < 0.001) as independent risk factors for adverse prognosis. MRMPP is associated with a prolonged disease course, more complex clinical features, and greater therapeutic challenges. However, macrolide resistance gene mutations alone do not predict adverse outcomes. Special attention should be given to patients with mucus plug formation and fever lasting > 6.5 days because they are at greater risk of unfavorable prognosis and may benefit from early intervention.