Association between point mutations of macrolide-resistant Mycoplasma pneumoniae and clinical antibiotic treatment efficacy: a meta-analysis
Abstract
Background The increasing macrolide resistance in Mycoplasma pneumoniae is mainly driven by mutations in the V domain of 23S rRNA (A2063G/A2064G), which impairs the efficacy of first-line treatment. Previous meta-analyses failed to distinguish between mutation subtypes or quantify age-specific susceptibility, blurring the clinical significance of different mutation burdens. Objective To quantify the differential impact of single mutation (A2063G) and double mutation (A2063G + A2064G) on core clinical outcomes and to dissect the age-adjusted effects between children and adults. Methods We searched PubMed, Web of Science, Embase, Scopus, and CNKI databases (up to June 2025). The Newcastle-Ottawa Scale was used to assess study quality. Random-effects models were applied to handle heterogeneity (I 2 > 50%), and subgroup analyses were conducted to compare mutation subtypes and age-stratified effects. Results A total of 53 studies (n = 8,960 individuals, covering 5 countries) were included. Double mutations significantly prolonged the duration of fever compared to single mutations (HR = 5.32, 95% CI: 4.27–6.61 vs. HR = 3.66, 95% CI: 1.89–7.09; P < 0.001) and were more likely to cause severe illness (HR = 7.80, 95% CI: 2.51–24.18 vs. HR = 5.89, 95% CI: 2.03–17.08). There was no difference in hospital stay between the two mutation subtypes, but both were longer than the wild type (MD = −3.33 days). The duration of fever in children was shorter than that in adults for all genotypes…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 8,960 participants or records.
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