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

1.8 Macrolide-resistant Mycoplasma pneumoniae (MRMP)

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]
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]

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]
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]
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]