{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:48:36Z","timestamp":1791478116990,"version":"4.3.4"},"reference-count":66,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"Special fundation for national science and technology basic research program of china","award":["2019FY101200"],"award-info":[{"award-number":["2019FY101200"]}]},{"name":"Scientific Research Project of Jiangsu Provincial Maternal and Child Health Care Association","award":["FYX202505"],"award-info":[{"award-number":["FYX202505"]}]},{"name":"Science and Technology Project of Suzhou Municipal Health Commission","award":["MSXM2025019"],"award-info":[{"award-number":["MSXM2025019"]}]},{"name":"Guided Project of Jiangsu Provincial Natural Science Foundation","award":["Z2025037"],"award-info":[{"award-number":["Z2025037"]}]},{"DOI":"10.13039\/100020761","name":"High Level Innovation and Entrepreneurial Research Team Program in Jiangsu","doi-asserted-by":"crossref","award":["2020-30191"],"award-info":[{"award-number":["2020-30191"]}],"id":[{"id":"10.13039\/100020761","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Government scholarship for studying abroad of jiangsu province","award":["2024-087"],"award-info":[{"award-number":["2024-087"]}]},{"name":"Medical research project of jiangsu commission of health","award":["M2020027"],"award-info":[{"award-number":["M2020027"]}]},{"name":"National tutorial system project of suzhou health young backbone talents","award":["Qngg2022011"],"award-info":[{"award-number":["Qngg2022011"]}]},{"name":"Gusu health talent program of suzhou","award":["2024-094"],"award-info":[{"award-number":["2024-094"]}]},{"DOI":"10.13039\/501100018556","name":"Science and Technology Program of Suzhou","doi-asserted-by":"publisher","award":["SYW2024103"],"award-info":[{"award-number":["SYW2024103"]}],"id":[{"id":"10.13039\/501100018556","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Key research program cultivation project of children's hospital of soochow university","award":["2023ZDPY02"],"award-info":[{"award-number":["2023ZDPY02"]}]},{"DOI":"10.13039\/100018916","name":"Suzhou Municipal Health Commission","doi-asserted-by":"publisher","award":["KJXW2023025"],"award-info":[{"award-number":["KJXW2023025"]}],"id":[{"id":"10.13039\/100018916","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      This study aimed to investigate the clinical characteristics, risk factors, and pathogen spectrum of mixed infections in children with\n                      <jats:italic toggle=\"yes\">Mycoplasma pneumoniae<\/jats:italic>\n                      pneumonia (MPP). A total of 1,428 pediatric MPP patients were retrospectively included and categorized into a single infection group (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 528) and a mixed infection group (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 900), with the latter further divided into bacterial, bacterial\u2013viral, and viral mixed infection subgroups. The results revealed that the children in the mixed infection group were younger (median 3\u20136 years vs 8 years,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) and had shorter hospital stays (8 days vs 9 days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) but had a higher incidence of severe pneumonia (30.44% vs 20.27%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Mixed infections occurred more frequently in autumn and presented with more prominent upper respiratory symptoms. Significant differences in the levels of some immune, coagulation, and inflammatory markers were detected between the two groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). The mixed infection group had higher rates of gastrointestinal dysfunction and myocardial injury. Multivariate regression analysis revealed longer cough duration, younger age, autumn onset, rhinorrhea, decreased complement C4 levels, and elevated antithrombin III (AT-III) levels as independent risk factors for mixed infection. Pathogen spectrum analysis revealed that\n                      <jats:italic toggle=\"yes\">Human rhinovirus<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">Streptococcus pneumoniae<\/jats:italic>\n                      were the predominant viral and bacterial pathogens, respectively, in mixed infections. Mixed infections accounted for a substantial proportion of the MPP cases (63.03%) and were associated with a higher risk of severe disease. It is recommended that active pathogen testing be conducted in children with MPP and that a prediction model incorporating age, season, symptoms, and laboratory indicators be developed for early identification and precise intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      This study highlights the importance of mixed infections in pediatric MPP patients. The results indicate that mixed infections account for up to 63.03% of MPP cases in children and are significantly associated with an increased risk of severe pneumonia. The key risk factors identified include younger age, autumn onset, rhinorrhea, decreased complement C4 levels, and elevated AT-III levels, providing a basis for the early identification of high-risk patients. Pathogen spectrum analysis identified\n                      <jats:italic toggle=\"yes\">human rhinovirus<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">Streptococcus pneumoniae<\/jats:italic>\n                      as the predominant mixed infecting pathogens. These findings suggest that multipathogen testing should be implemented for children with MPP. This research supports the development of a risk prediction model to enable early warning and targeted intervention, thereby optimizing treatment, improving prognosis, and enhancing public health prevention and control strategies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.03884-25","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T13:07:46Z","timestamp":1778591266000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":3,"title":["Clinical characteristics, risk factors, and pathogen spectrum of mixed infections in children with\n                    <i>Mycoplasma pneumoniae<\/i>\n                    pneumonia: a retrospective cohort study of 1,428 cases from a children\u2019s medical centre in East China"],"prefix":"10.1128","volume":"14","author":[{"given":"Cheng","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Children's Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4422-9139","authenticated-orcid":true,"given":"Shenghao","family":"Hua","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Children's Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Children's Hospital of Soochow University","place":["Suzhou, China"]},{"name":"Institute of Pediatric Research, Children's Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Children's Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lunjing","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Children's Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4853-2634","authenticated-orcid":false,"given":"Xuejun","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Children's Hospital of Soochow University","place":["Suzhou, China"]},{"name":"Institute of Pediatric Research, Children's Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0644-6744","authenticated-orcid":false,"given":"Jun","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Children's Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3567-1791","authenticated-orcid":true,"given":"Xin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Children's Hospital of Soochow University","place":["Suzhou, China"]},{"name":"Institute of Pediatric Research, Children's Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2025.40.e317"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-024-05519-1"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcr\/ytaf467"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-023-01545-1"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/9328177"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2025.1552144"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.7499\/j.issn.1008-8830.2411162"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000005037"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112140-20231227-00466"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00114-16"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12111623"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jix642"},{"key":"e_1_3_5_14_2","first-page":"126","article-title":"Pathogenic analysis and clinical characteristics of community-acquired pneumonia in children in Beijing from 2018 to 2019","volume":"12","author":"Fu YL","year":"2022","unstructured":"Fu YL, DongY, LiJ. 2022. Pathogenic analysis and clinical characteristics of community-acquired pneumonia in children in Beijing from 2018 to 2019. Chin J Med Sci 12:126\u2013129.","journal-title":"Chin J Med Sci"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.2095-0616.2022.08.032"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-024-09340-x"},{"key":"e_1_3_5_17_2","volume-title":"Zhu Futang\u2019s practical pediatrics","author":"Zhu FT","year":"2015","unstructured":"Zhu FT. 2015. Zhu Futang\u2019s practical pediatrics. 8th ed. People\u2019s Medical Publishing House, Beijing.","edition":"8"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112140-20240728-00523"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn331340-20230217-00023"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7423a1"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.58757"},{"key":"e_1_3_5_22_2","first-page":"251","article-title":"Epidemiological characteristics and related risk factors of mixed infection in children with mycoplasma pneumoniae pneumonia","volume":"47","author":"Lv W","year":"2024","unstructured":"Lv W, Guo C, Lv G, Xi X. 2024. Epidemiological characteristics and related risk factors of mixed infection in children with mycoplasma pneumoniae pneumonia. New Microbiol 47:251\u2013257.","journal-title":"New Microbiol"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000366"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.22514\/sv.2020.16.0087"},{"key":"e_1_3_5_25_2","unstructured":"Chinese Center for Disease Control and Prevention. 2025. National weekly report on respiratory infection surveillance. Beijing"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1006-2483.2025.04.015"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1009-6663.2025.09.014"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-5247(23)00344-0"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/all.13624"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1006-6179.2020.01.005"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2021.07.003"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.732163"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.186346"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.574457"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.00881-09"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.22533\/at.ed.159562515013"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1126\/sciimmunol.ade2335"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2025.106642"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0071316"},{"key":"e_1_3_5_40_2","first-page":"319","article-title":"Alterations of antithrombin III after acute myocardial infarction","volume":"115","author":"Oehler G","year":"1988","unstructured":"Oehler G, B\u00fcdinger M, Heinrich D, Sch\u00f6ndorf T. 1988. Alterations of antithrombin III after acute myocardial infarction. Folia Haematol Int Mag Klin Morphol Blutforsch 115:319\u2013323.","journal-title":"Folia Haematol Int Mag Klin Morphol Blutforsch"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-30201"},{"key":"e_1_3_5_42_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200009001-00008"},{"key":"e_1_3_5_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2016.11.007"},{"key":"e_1_3_5_44_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13911"},{"key":"e_1_3_5_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2021.02.025"},{"key":"e_1_3_5_46_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0510644103"},{"key":"e_1_3_5_47_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1462-5822.2009.01309.x"},{"key":"e_1_3_5_48_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2025.1661684"},{"key":"e_1_3_5_49_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2016.00023"},{"key":"e_1_3_5_50_2","doi-asserted-by":"publisher","DOI":"10.3892\/etm.2024.12559"},{"key":"e_1_3_5_51_2","doi-asserted-by":"publisher","DOI":"10.21037\/tp-20-471"},{"key":"e_1_3_5_52_2","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S541396"},{"key":"e_1_3_5_53_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-94292-8"},{"key":"e_1_3_5_54_2","unstructured":"World Health Organization. 2023. World Health Organization. Global respiratory virus epidemiology map 2023. Geneva World Health Organization"},{"key":"e_1_3_5_55_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1405870"},{"key":"e_1_3_5_56_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-025-10712-0"},{"key":"e_1_3_5_57_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-024-03380-4"},{"key":"e_1_3_5_58_2","first-page":"15666","article-title":"Effects of bacterial and viral co-infections of Mycoplasma pneumoniae pneumonia in children: analysis report from Beijing Children\u2019s Hospital between 2010 and 2014","volume":"8","author":"Song Q","year":"2015","unstructured":"Song Q, Xu BP, Shen KL. 2015. Effects of bacterial and viral co-infections of Mycoplasma pneumoniae pneumonia in children: analysis report from Beijing Children\u2019s Hospital between 2010 and 2014. Int J Clin Exp Med 8:15666\u201315674.","journal-title":"Int J Clin Exp Med"},{"key":"e_1_3_5_59_2","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112140-20230723-00025"},{"key":"e_1_3_5_60_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13312-016-0951-8"},{"key":"e_1_3_5_61_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-025-05230-5"},{"key":"e_1_3_5_62_2","unstructured":"Chinese Center for Disease Control and Prevention. 2025. Epidemiological Trends Report of Respiratory Pathogens in Children. Beijing Chinese Center for Disease Control and Prevention"},{"key":"e_1_3_5_63_2","doi-asserted-by":"publisher","DOI":"10.12372\/jcp.2025.24e1156"},{"key":"e_1_3_5_64_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01279-25"},{"key":"e_1_3_5_65_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2025.103034"},{"key":"e_1_3_5_66_2","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1674-4985.2021.19.003"},{"key":"e_1_3_5_67_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.81687"}],"container-title":["Microbiology Spectrum"],"original-title":[],"contributor":[{"given":"Xinxing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"reviewer"}]},{"given":"Yue","family":"Tao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"reviewer"}]},{"given":"Qing","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"reviewer"}]}],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.03884-25","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.03884-25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T13:13:23Z","timestamp":1781702003000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.03884-25"}},"subtitle":[],"editor":[{"given":"Ping","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":66,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,2]]}},"alternative-id":["10.1128\/spectrum.03884-25"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.03884-25","relation":{},"ISSN":["2165-0497"],"issn-type":[{"value":"2165-0497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"assertion":[{"value":"2025-12-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e03884-25"}}