Pathogen Distribution and Antimicrobial Resistance Patterns in Pediatric Lower Respiratory Tract <i>Mycoplasma pneumoniae</i> Pneumonia

We aimed to characterize the distribution of respiratory pathogens and antimicrobial resistance profiles in children with lower respiratory tract Mycoplasma pneumoniae pneumonia (MPP) and to identify clinical factors associated with multidrug-resistant (MDR) infection. A retrospective analysis of 125 pediatric MPP patients was conducted. Microbiological identification and antimicrobial susceptibility testing were performed on bronchoalveolar lavage fluid isolates. Based on susceptibility results, patients were categorized into an MDR group (n = 25) and a non-MDR group (n = 100). Multivariate logistic regression identified independent predictors of MDR infection. Among Gram-negative isolates, Klebsiella pneumoniae had the highest resistance to cefotaxime (40%), Escherichia coli to piperacillin (50%), and Pseudomonas aeruginosa to aztreonam (54%). For Gram-positive bacteria, resistance to penicillin was most pronounced in Staphylococcus aureus (76%) and Streptococcus pneumoniae (83%). Staphylococcus epidermidis showed elevated resistance to clindamycin, levofloxacin, and penicillin (43% each). Multivariate analysis identified prolonged hospitalization (≥ 14 days), antibiotic exposure for ≥ 7 days, and invasive respiratory procedures as independent risk factors for MDR infection (p < 0.05). Co-isolated bacterial pathogens from children with lower respiratory tract MPP show notable antimicrobial resistance. Routine pathogen testing and susceptibility profiling are crucial for guiding targeted therapy and curbing multidrug resistance.