Risk factors for multiple bronchoalveolar lavage procedures in children with severe or refractory Mycoplasma pneumoniae pneumonia

OBJECTIVE: To identify factors influencing how often bronchoalveolar lavage (BAL) is performed in children with severe or refractory Mycoplasma pneumoniae pneumonia (MPP) and provide evidence to guide early intervention. METHODS: Clinical data for 271 children with severe or refractory MPP who underwent BAL at the studied institution between May 1, 2023, and April 30, 2024, were retrospectively divided according to the number of BAL procedures into a single-treatment group (STG, n = 219) and a multiple-treatment group (≥ 2 times; MTG, n = 52). Risk factors for multiple BAL procedures in these children were identified by logistic regression and receiver-operating characteristic curve analyses. RESULTS: Peak body temperature was significantly higher, duration of fever was significantly longer, and pulmonary consolidation, pleural effusion, atelectasis, mucus plug formation, and pulmonary lesions involving two or more lung lobes were significantly more common in the MTG than in the STG (all P < 0.05). The white blood cell count, neutrophil percentage, and C-reactive protein (CRP), lactate dehydrogenase (LDH), fibrinogen, and D-dimer levels were significantly higher and the lymphocyte percentage was significantly lower in the MTG (P < 0.05). Logistic regression and receiver-operating characteristic curve analyses showed that mucus plug formation, CRP ≥ 25.68 mg/L, LDH ≥ 374.90 U/L, and D-dimer ≥ 1.22 mg/L were independent risk factors for multiple BAL in children with severe or refractory MPP. CONCLUSION: Mucus plug formation and increased CRP, LDH, and D-dimer levels are important risk factors for multiple BAL in children with severe or refractory MPP. Pediatricians should strengthen management and early intervention in these children to avoid the harm caused by multiple BAL procedures.