Etiology of pediatric community-acquired pneumonia across Mycoplasma pneumoniae epidemic periods

Community-acquired pneumonia (CAP) remains a leading cause of hospitalization and antibiotic use in children, yet etiologic data during Mycoplasma pneumoniae epidemic periods—now resurging globally after the COVID-19 pandemic—remain scarce. We conducted a nationwide prospective surveillance study across 17 hospitals in Korea between September 2023 and May 2025, enrolling 740 children with CAP. Etiology was determined using standardized criteria: pyogenic bacteria by culture with central adjudication, atypical bacteria by polymerase chain reaction (PCR) and serology, and viruses by PCR (excluding human rhinovirus/enterovirus, bocavirus, and coronavirus, given their uncertain causal role). An etiologic pathogen was identified in 541 children (73.1%), with atypical pathogens predominating (43.6%), followed by viral (26.8%) and pyogenic (2.7%) etiologies. During the peak M. pneumoniae epidemic period (June 2024–January 2025), atypical CAP accounted for 57.0% of cases, whereas the odds of pyogenic CAP were 66% lower than in other periods (Firth penalized odds ratio, 0.34; 95% CI, 0.13–0.81). In exploratory multivariable analysis, pyogenic CAP was associated with prolonged hospitalization, respiratory support, and intensive care unit admission. These findings may inform empirical antibiotic decision-making in hospitalized children with CAP during M. pneumoniae epidemic periods, while early recognition of the rare but severe pyogenic CAP remains essential.

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Journal
Scientific Reports
Published
2026-08-25
DOI
https://doi.org/10.1038/s41598-026-67623-6
Primary Topic
Pneumonia and Respiratory Infections
Type
article
Field-Weighted Citation Impact
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article

Etiology of pediatric community-acquired pneumonia across Mycoplasma pneumoniae epidemic periods

Woosuck Suh, Ki Wook Yun, Soo‐Han Choi, Taek-Jin Lee et al.
Scientific Reports
Pneumonia and Respiratory Infections
article

Etiology of pediatric community-acquired pneumonia across Mycoplasma pneumoniae epidemic periods

Woosuck Suh, Ki Wook Yun, Soo‐Han Choi, Taek-Jin Lee, Hyejin So, Ye Ji Kim, Young June Choe, Ye Kyung Kim, Byung Ok Kwak, Kyung-Ran Kim, Kyo Jin Jo, Doo Ri Kim, Dae Sun Jo, Byung Wook Eun, Hyunju Lee, Gahee Kim, Yong-Hee Lee
article en

Abstract

Community-acquired pneumonia (CAP) remains a leading cause of hospitalization and antibiotic use in children, yet etiologic data during Mycoplasma pneumoniae epidemic periods—now resurging globally after the COVID-19 pandemic—remain scarce. We conducted a nationwide prospective surveillance study across 17 hospitals in Korea between September 2023 and May 2025, enrolling 740 children with CAP. Etiology was determined using standardized criteria: pyogenic bacteria by culture with central adjudication, atypical bacteria by polymerase chain reaction (PCR) and serology, and viruses by PCR (excluding human rhinovirus/enterovirus, bocavirus, and coronavirus, given their uncertain causal role). An etiologic pathogen was identified in 541 children (73.1%), with atypical pathogens predominating (43.6%), followed by viral (26.8%) and pyogenic (2.7%) etiologies. During the peak M. pneumoniae epidemic period (June 2024–January 2025), atypical CAP accounted for 57.0% of cases, whereas the odds of pyogenic CAP were 66% lower than in other periods (Firth penalized odds ratio, 0.34; 95% CI, 0.13–0.81). In exploratory multivariable analysis, pyogenic CAP was associated with prolonged hospitalization, respiratory support, and intensive care unit admission. These findings may inform empirical antibiotic decision-making in hospitalized children with CAP during M. pneumoniae epidemic periods, while early recognition of the rare but severe pyogenic CAP remains essential.

Scientific Reports
Changwon National University (KR), Chungnam National University (KR), Samsung Medical Center (KR), Seoul National University Bundang Hospital (KR), Konkuk University Medical Center (KR), St. Mary's Hospital (US), Hallym University Kangnam Sacred Heart Hospital (KR), Chosun University Hospital (KR), Seoul National University Children's Hospital (KR), Kangwon National University Hospital (KR), The Catholic University of Korea Daejeon St. Mary's Hospital (KR), St. Mary's Hospital (US), Pusan National University Hospital (KR), Jeonbuk National University Hospital (KR), CHA University Bundang Medical Center (KR), CHA University (KR), Pusan National University Yangsan Hospital (KR), Inha University Hospital (KR), The Catholic University of Korea Seoul St. Mary's Hospital (KR), Korea University (JP), Eulji Medical Center (KR), Gyeongsang National University Changwon Hospital (KR), Chungnam National University Sejong Hospital (KR), Jeonbuk National University (KR), Sungkyunkwan University (KR)
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