Background

The prevalence of macrolide-resistant Mycoplasma pneumoniae (MP) pneumonia has been rapidly increased. MP pneumonia is a risk factor for the development of post-infectious bronchiolitis obliterans (PIBO). The aim of the present study was to identify the risk factors for the development of PIBO after MP pneumonia in the era of increasing macrolide resistance of MP.

Materials and methods

This retrospective study enrolled 150 children with a mean age of 6.0 years admitted to the hospital due to MP pneumonia between May 2019 and February 2020 at a tertiary hospital. The clinical, radiologic, and laboratory data were obtained using retrospective chart review.

Results

Eighteen children (12%) were diagnosed with PIBO after MP pneumonia. PIBO was diagnosed after a mean duration of 100.0 days (range, 6–268 days) from symptom onset. The respiratory virus co-infection (adjusted odds ratio [aOR], 4.069; 95% confidence interval [95% CI], 1.224–13.523), adenovirus co-infection (aOR, 5.607; 95% CI, 1.801–17.454), longer duration between symptom onset and admission (aOR, 1.150; 95% CI, 1.020–1.298), higher levels of serum lactate dehydrogenase (LDH) at the time of admission (aOR, 1.001; 95% CI, 1.000–1.003), and poor response to stepwise treatment increased the risk for development of PIBO after MP pneumonia. However, macrolide resistance of MP was not associated with development of PIBO after MP pneumonia.

Conclusion

The present study suggests that respiratory virus co-infection, including adenovirus, poor response to the treatment of MP pneumonia, and higher levels of serum LDH, but not macrolide resistance of MP, are risk factors of PIBO after MP pneumonia.

中文翻译：

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大环内酯类耐药增加时代肺炎支原体肺炎发生感染后闭塞性细支气管炎的危险因素

背景

大环内酯类耐药肺炎支原体（MP）肺炎的患病率迅速增加。MP 肺炎是感染后闭塞性细支气管炎 (PIBO) 发展的危险因素。本研究的目的是确定在 MP 对大环内酯类耐药性增加的时代 MP 肺炎后发生 PIBO 的危险因素。

材料和方法

这项回顾性研究纳入了 2019 年 5 月至 2020 年 2 月在三级医院因 MP 肺炎入院的 150 名平均年龄为 6.0 岁的儿童。使用回顾性图表审查获得临床、放射学和实验室数据。

结果

18 名儿童 (12%) 在 MP 肺炎后被诊断出患有 PIBO。PIBO 在症状出现后平均持续 100.0 天（范围，6-268 天）后被诊断出来。呼吸道病毒合并感染（调整后的比值比 [aOR]，4.069；95% 置信区间 [95% CI]，1.224–13.523），腺病毒合并感染（aOR，5.607；95% CI，1.801–17.454），时间更长症状发作和入院之间的持续时间（aOR，1.150；95% CI，1.020–1.298），入院时血清乳酸脱氢酶（LDH）水平较高（aOR，1.001；95% CI，1.000–1.003），差对逐步治疗的反应增加了 MP 肺炎后发生 PIBO 的风险。然而，MP 的大环内酯耐药性与 MP 肺炎后 PIBO 的发展无关。

结论

本研究提示呼吸道病毒合并感染包括腺病毒、对 MP 肺炎治疗反应差、血清 LDH 水平升高，但 MP 对大环内酯类耐药不存在，是 MP 肺炎后 PIBO 的危险因素。