Clinical score for early escalation in pediatric A2063G Mycoplasma pneumoniae pneumonia: a retrospective cohort study
Abstract
BACKGROUND: Macrolide-resistant Mycoplasma pneumoniae (MRMP), primarily driven by the 23 S rRNA A2063G mutation, is increasingly prevalent among East Asian children, diminishing azithromycin efficacy. Although some patients benefit from its anti-inflammatory properties, delayed escalation in non-responders can prolong fever and increase complications. Given the age-related risks of tetracyclines and fluoroquinolones, determining which children truly require second-line therapy remains a clinical challenge. METHODS: We retrospectively reviewed 112 children with MRMP carrying the 23 S rRNA A2063G mutation. Patients were categorized into an azithromycin group (n = 66) and a second-line therapy group (n = 46). Between-group comparisons were performed using the χ² test, independent-sample t test, or Mann-Whitney U test. Independent predictors of escalation were identified via multivariable logistic regression, and model performance was assessed using receiver operating characteristic (ROC) analysis. RESULTS: Compared with the second-line group, the azithromycin group had longer fever duration (median 7.00 vs. 5.00 days, P = 0.003) and slightly higher peak temperatures (39.20 °C vs. 39.00 °C, P = 0.016). In contrast, escalated patients exhibited significantly higher procalcitonin (PCT) levels (1.23 vs. 0.30 ng/mL, P < 0.001), greater chest CT total severity scores (TSS) (13.50 vs. 4.00, P < 0.001), and more frequent Streptococcus pneumoniae co-infection (65.22% vs. 39.39%, P =…
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