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Chapters

Part I: Antibiotic Resistance (AMR) - Global and Local Epidemiology



1.8 Macrolide-resistant Mycoplasma pneumoniae (MRMP)



  1. The proportion of community-acquired bacterial pneumonias caused by Mycoplasma pneumoniae varies according to age, with school-age children and adolescents being the most common age groups affected, but this organism can cause infections in persons from infancy up through old age. [112,113]

  2. MRMP was first reported in Japan in 2001. [114] Since then, there have been reports in China, [115–118] Taiwan, [118,119] Korea, [120] the United States of America, [120,121] and various European countries, including Scotland, [122] Spain, [123] and Germany. [124]

  1. In China, MRMP prevalence is exceptionally high, accounting for over 90% of all M. pneumoniae detections, potentially due to selective testing of failure cases. [116] Hong Kong reported its first imported MRMP case in 2009, in an adult returning from Xi’an, [125] followed by its first locally acquired case in 2010. [126]

  2. Two local studies have explored MRMP rates among hospitalised patients. The first study assessed various molecular methods for detecting genotypic resistance in M. pneumoniae in both adults and children. [127] Pyrosequencing detected the A2063G mutation in 79% of M. pneumoniae PCR-positive cases, whereas Sanger sequencing and melting curve analysis identified the mutation in less than 40% of cases. The difference is mainly due to the ability of pyrosequencing to identify low-frequency MRMP quasispecies. In a retrospective review of 48 children hospitalised for Mycoplasma pneumoniae infection from March 2010 to March 2013, MRMP accounted for 70% of M. pneumoniae-related community-acquired pneumonia cases. Doxycycline was significantly more effective than macrolide for treatment of MRMP-related community-acquired pneumonia in terms of achievement of rapid defervescence within 24 hours. [128]

  3. The prevalence of M. pneumoniae infection fluctuates over time, with peak disease occurrences observed every 3 to 7 years. While detection rates vary by age groups (Figure 1.5, Figure 1.6), the prevalence of MRMP remains consistently high. [128,129]

The bar chart titled 'Prevalence of Mycoplasma pneumoniae in respiratory specimens according to patient age groups, all HA hospitals, 2023' illustrates the prevalence of Mycoplasma pneumoniae in respiratory specimens across different age groups in all HA hospitals in 2023. The x-axis represents five age groups: 0-1, 2-11, 12-17, 18-64, and ≥65 years. The y-axis shows the prevalence percentage ranging from 0 to 15%. For the 0-1 year age group, the prevalence is 2.0% (4 out of 197 specimens). For the 2-11 year age group, the prevalence is the highest at 11.5% (265 out of 2307 specimens). For the 12-17 year age group, the prevalence is 10.5% (56 out of 533 specimens). For the 18-64 year age group, the prevalence is lower at 1.3% (55 out of 4122 specimens). For the ≥65 year age group, the prevalence is the lowest at 0.1% (6 out of 5880 specimens). The highest prevalence is observed in children aged 2 to 17 years, while adults aged ≥65 years have the lowest prevalence.
Figure 1.5: Prevalence of Mycoplasma pneumoniae in Respiratory Specimens According to Patient Age Groups, All HA Hospitals, 2023



The figure titled 'Prevalence of Mycoplasma pneumoniae and Its Macrolide Resistance in Respiratory Specimens (December 2023 to June 2024 from QMH)' consists of two bar charts side by side, illustrating data on the prevalence of Mycoplasma pneumoniae in different age groups and the percentage of macrolide-resistant cases. Left Bar Chart: Prevalence of Mycoplasma pneumoniae. The x-axis represents five age groups: 0-1 years (673 specimens); 2-11 years (1655 specimens); 12-17 years (296 specimens); 18-64 years (341 specimens); ≥65 years (384 specimens). The y-axis shows the percentage prevalence. The prevalence values for each age group are: 0-1 years: 1%; 2-11 years: 11%; 12-17 years: 14%; 18-64 years: 4%; ≥65 years: 0%. Right Bar Chart: Percentage of Mycoplasma pneumoniae Tested Macrolide-Resistant. The x-axis represents the same five age groups as the left chart. The y-axis shows the percentage of macrolide-resistant cases. The resistance percentages for each age group are: 0-1 years: 43%; 2-11 years: 64%; 12-17 years: 57%; 18-64 years: 63%' ≥65 years: N/A (no data available). Both charts use dark gray bars to represent the data, with percentage values labeled above each bar.
Figure 1.6: Prevalence of Macrolide Resistance Among Mycoplasma pneumoniae, QMH.
The figure titled 'Resistance Trends of E. coli, Klebsiella spp., and Enterococcus in Blood and Non-Blood Specimens (2008–2023)' consists of four panels showing the resistance trends of Vancomycin-resistant Enterococcus faecalis/Enterococcus faecium and Escherichia coli non-susceptible to Carbapenems in blood and non-blood specimens from 2008 to 2023. Each panel contains two types of graphs: a line chart (black dots) showing the percentage of isolates resistant or non-susceptible, and a bar chart showing the count of resistant isolates. Top Panels: Vancomycin-resistant Enterococcus faecalis/Enterococcus faecium: Blood specimens (left): The line chart shows a low resistance trend, fluctuating between 0% and 2.5% from 2008 to 2023, with no significant increase. Non-blood specimens (right): A sharp rise in resistance is observed between 2012 and 2014, peaking at around 7.5%, followed by a decrease and a resurgence in 2023 to around 5%. The bar chart shows a significant rise in the count of resistant isolates, especially in recent years (2021–2023), reaching approximately 200 in 2023. Bottom Panels: Escherichia coli non-susceptible to Carbapenems: Blood specimens (left): The line chart shows a gradual increase in non-susceptibility, peaking at around 0.75% in 2023. The bar chart shows consistent counts of non-susceptible isolates, with a slight increase in recent years. Non-blood specimens (right): The line chart shows a gradual rise in non-susceptibility, reaching about 1.5% in 2023. The bar chart depicts a sharp increase in the count of non-susceptible isolates, reaching nearly 500 in 2023. Legend: Line chart (black dots) represents the percentage of isolates resistant or non-susceptible. Bar chart represents the count of isolates resistant or non-susceptible. Color coding: Orange for Vancomycin and Green for Carbapenems (Imipenem, Meropenem, or Ertapenem). Isolates were de-duplicated using the 'first isolate per patient per calendar year' method. Screening specimens are excluded.
Figure 1.7: Resistance Trends of Escherichia coli, Klebsiella spp., and Enterococcus in Blood and Non-Blood Specimens (2008–2023)
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