{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:47:58Z","timestamp":1788414478952,"version":"build-2803163510"},"reference-count":73,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      This study investigates the current status of macrolide resistance in\n                      <jats:italic>Mycoplasma pneumoniae (MP)<\/jats:italic>\n                      and analyzes the relationship between mutations at the 23S rRNA A2063G and\/or A2064G loci and refractory\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      pneumonia (RMPP).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective analysis was conducted on 205 hospitalized children diagnosed with MPP at the Third Ward of the department of paediatrics, Jingzhou Central Hospital, from October 2023 to October 2024. Diagnosis was confirmed by pharyngeal\n                      <jats:italic>MP<\/jats:italic>\n                      nucleic acid testing and\n                      <jats:italic>MP<\/jats:italic>\n                      antibody titers (\n                      <jats:italic>MP<\/jats:italic>\n                      -Ab\u2009\u2265\u20091:160). All patients were screened for macrolide-resistant gene mutations (A2063G\/A2064G). Patients were categorized based on the presence of macrolide-resistant gene mutations and RMPP diagnosis. Clinical features, laboratory results, and treatments were compared between groups. Multiple logistic regression was used to identify independent risk factors for RMPP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 205 children with MPP, 157 (76.6%) harbored A2063G\/A2064G mutations. Of the 77 children with RMPP, 71 (92.2%) carried these mutations, showing a significant association (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Compared to the non-resistant group, children with resistant mutations had prolonged fever duration, delayed defervescence after azithromycin, and required more bronchoscopic alveolar lavage (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). The RMPP group exhibited more severe symptoms, longer fever and hospital stays, higher inflammatory markers (CRP, LDH, D-dimer, ESR, PCT;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), and more frequent pulmonary consolidation, pleural effusion, plastic bronchitis, and extrapulmonary involvement. Multivariate analysis identified macrolide-resistant mutations, fever duration, and D-dimer level as independent risk factors for RMPP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The widespread macrolide resistance in\n                      <jats:italic>M. pneumoniae<\/jats:italic>\n                      (76.6% in this cohort) was associated with point mutations at the A2063G and\/or A2064G loci in the 23S rRNA gene. The development of RMPP is linked to macrolide-resistant mutations, duration of fever and D-dimer levels. D-dimer emerged as the most predictive risk factor.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0341580","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T18:26:16Z","timestamp":1769711176000},"page":"e0341580","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Association analysis of Mycoplasma pneumoniae 23S rRNA gene mutation with refractory Mycoplasma pneumoniae pneumonia in children"],"prefix":"10.1371","volume":"21","author":[{"given":"Wen","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3879-8102","authenticated-orcid":true,"given":"Aimin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"issue":"11","key":"pone.0341580.ref001","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1007\/s12519-022-00592-8","article-title":"Pathogenic changes of community-acquired pneumonia in a children\u2019s hospital in Beijing, China before and after COVID-19 onset: A retrospective study","volume":"18","author":"L-N Zhang","year":"2022","journal-title":"World J Pediatr"},{"issue":"12","key":"pone.0341580.ref002","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1016\/j.rmed.2008.06.022","article-title":"Epidemiology and clinical features of Mycoplasma pneumoniae infection in children","volume":"102","author":"A Defilippi","year":"2008","journal-title":"Respir Med"},{"issue":"1","key":"pone.0341580.ref003","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/cid\/ciy419","article-title":"Mycoplasma pneumoniae Among Children Hospitalized With Community-acquired Pneumonia","volume":"68","author":"PK Kutty","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"3","key":"pone.0341580.ref004","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jinf.2008.06.012","article-title":"Methylprednisolone pulse therapy for refractory Mycoplasma pneumoniae pneumonia in children","volume":"57","author":"A Tamura","year":"2008","journal-title":"J Infect"},{"issue":"03","key":"pone.0341580.ref005","first-page":"196","article-title":"Guidelines for diagnosis and treatment of mycoplasma pneumoniae pneumonia in children (2023 edition)","volume":"21","author":"Commission National Health","year":"2023","journal-title":"Clinical Educ General Practice"},{"key":"pone.0341580.ref006","doi-asserted-by":"crossref","first-page":"9227838","DOI":"10.1155\/2022\/9227838","article-title":"Refractory mycoplasma pneumonia in children: A systematic review and meta-analysis of laboratory features and predictors","volume":"2022","author":"W Huang","year":"2022","journal-title":"J Immunol Res"},{"issue":"10","key":"pone.0341580.ref007","doi-asserted-by":"crossref","first-page":"2824","DOI":"10.3390\/jcm11102824","article-title":"Refractory Mycoplasma pneumoniae Pneumonia in Children: Early Recognition and Management","volume":"11","author":"L Tong","year":"2022","journal-title":"J Clin Med"},{"issue":"4","key":"pone.0341580.ref008","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1128\/CMR.17.4.697-728.2004","article-title":"Mycoplasma pneumoniae and its role as a human pathogen","volume":"17","author":"KB Waites","year":"2004","journal-title":"Clin Microbiol Rev"},{"issue":"3","key":"pone.0341580.ref009","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1128\/CMR.00114-16","article-title":"Mycoplasma pneumoniae from the respiratory tract and beyond","volume":"30","author":"KB Waites","year":"2017","journal-title":"Clin Microbiol Rev"},{"key":"pone.0341580.ref010","unstructured":"Respiratory Subspecialty Group of the Pediatrics Branch CMA, Editorial Board of Chinese Journal of Pediatrics, Pediatric Professional Committee of the Chinese Medical Education Association. Guidelines for the management of community-acquired pneumonia in children (2024 revision). Chinese Journal of Pediatrics. 2024;62(10):920\u201330."},{"issue":"2","key":"pone.0341580.ref011","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/00001432-200104000-00012","article-title":"Mycoplasma pneumoniae infections","volume":"14","author":"MR Hammerschlag","year":"2001","journal-title":"Curr Opin Infect Dis"},{"issue":"9","key":"pone.0341580.ref012","doi-asserted-by":"crossref","first-page":"949","DOI":"10.2174\/1568026033452159","article-title":"Macrolide antibiotics: binding site, mechanism of action, resistance","volume":"3","author":"M Gaynor","year":"2003","journal-title":"Curr Top Med Chem"},{"key":"pone.0341580.ref013","first-page":"320801","article-title":"Drug resistance mechanisms of Mycoplasma pneumoniae to macrolide antibiotics","volume":"2014","author":"X Liu","year":"2014","journal-title":"Biomed Res Int"},{"issue":"14","key":"pone.0341580.ref014","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.3748\/wjg.v24.i14.1531","article-title":"Punctual mutations in 23S rRNA gene of clarithromycin-resistant Helicobacter pylori in Colombian populations","volume":"24","author":"AJ Matta","year":"2018","journal-title":"World J Gastroenterol"},{"issue":"4","key":"pone.0341580.ref015","doi-asserted-by":"crossref","first-page":"423","DOI":"10.2217\/fmb.11.18","article-title":"Mycoplasma pneumoniae: susceptibility and resistance to antibiotics","volume":"6","author":"C B\u00e9b\u00e9ar","year":"2011","journal-title":"Future Microbiol"},{"issue":"3","key":"pone.0341580.ref016","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1093\/jac\/dks457","article-title":"Macrolide-resistant Mycoplasma pneumoniae: Its role in respiratory infection","volume":"68","author":"N Principi","year":"2013","journal-title":"J Antimicrob Chemother"},{"issue":"6","key":"pone.0341580.ref017","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.3201\/eid1706.101558","article-title":"Macrolide resistance in Mycoplasma pneumoniae, Israel, 2010","volume":"17","author":"D Averbuch","year":"2011","journal-title":"Emerg Infect Dis"},{"issue":"5","key":"pone.0341580.ref018","doi-asserted-by":"crossref","first-page":"20075","DOI":"10.2807\/ese.17.05.20075-en","article-title":"Surveillance status and recent data for Mycoplasma pneumoniae infections in the European Union and European Economic Area, January 2012","volume":"17","author":"A Lenglet","year":"2012","journal-title":"Euro Surveill"},{"issue":"10","key":"pone.0341580.ref019","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.3201\/eid2310.170106","article-title":"Macrolide-resistant mycoplasma pneumoniae infection, Japan, 2008-2015","volume":"23","author":"T Tanaka","year":"2017","journal-title":"Emerg Infect Dis"},{"issue":"6","key":"pone.0341580.ref020","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1002\/jgf2.201","article-title":"Clinical features and seasonal variations in the prevalence of macrolide-resistant Mycoplasma pneumoniae","volume":"19","author":"Y Akashi","year":"2018","journal-title":"J Gen Fam Med"},{"issue":"8","key":"pone.0341580.ref021","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.3201\/eid2108.150273","article-title":"Macrolide-Resistant Mycoplasma pneumoniae, United States","volume":"21","author":"X Zheng","year":"2015","journal-title":"Emerg Infect Dis"},{"issue":"5","key":"pone.0341580.ref022","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1128\/AAC.01563-08","article-title":"Molecular mechanisms of macrolide resistance in clinical isolates of Mycoplasma pneumoniae from China","volume":"53","author":"D Xin","year":"2009","journal-title":"Antimicrob Agents 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pneumoniae quasispecies in respiratory specimens","volume":"51","author":"K-H Chan","year":"2013","journal-title":"J Clin Microbiol"},{"issue":"1","key":"pone.0341580.ref026","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1046\/j.1365-2958.2000.01841.x","article-title":"Macrolide-ketolide inhibition of MLS-resistant ribosomes is improved by alternative drug interaction with domain II of 23S rRNA","volume":"36","author":"S Douthwaite","year":"2000","journal-title":"Mol Microbiol"},{"issue":"11","key":"pone.0341580.ref027","doi-asserted-by":"crossref","first-page":"3534","DOI":"10.1128\/JCM.01345-07","article-title":"First report of macrolide-resistant strains and description of a novel nucleotide sequence variation in the P1 adhesin gene in Mycoplasma pneumoniae clinical strains isolated in France over 12 years","volume":"45","author":"S Pereyre","year":"2007","journal-title":"J Clin Microbiol"},{"issue":"7","key":"pone.0341580.ref028","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.3201\/eid2607.200017","article-title":"Macrolide-Resistant Mycoplasma pneumoniae infections in pediatric community-acquired pneumonia","volume":"26","author":"Y-C Chen","year":"2020","journal-title":"Emerg Infect Dis"},{"issue":"7","key":"pone.0341580.ref029","article-title":"Global trends in the proportion of macrolide-resistant mycoplasma pneumoniae infections: A systematic review and meta-analysis","volume":"5","author":"K Kim","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"1","key":"pone.0341580.ref030","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1080\/22221751.2022.2078228","article-title":"Mycoplasma pneumoniae triggers pneumonia epidemic in autumn and winter in Beijing: A multicentre, population-based epidemiological study between 2015 and 2020","volume":"11","author":"X Wang","year":"2022","journal-title":"Emerg Microbes Infect"},{"key":"pone.0341580.ref031","doi-asserted-by":"crossref","first-page":"800","DOI":"10.3389\/fmicb.2016.00800","article-title":"Clinical features of severe or fatal mycoplasma pneumoniae pneumonia","volume":"7","author":"K Izumikawa","year":"2016","journal-title":"Front Microbiol"},{"key":"pone.0341580.ref032","doi-asserted-by":"crossref","first-page":"37037","DOI":"10.1038\/srep37037","article-title":"Cytokines as the good predictors of refractory Mycoplasma pneumoniae pneumonia in school-aged children","volume":"6","author":"Y Zhang","year":"2016","journal-title":"Sci Rep"},{"issue":"4","key":"pone.0341580.ref033","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1542\/peds.113.4.701","article-title":"Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children","volume":"113","author":"IC Michelow","year":"2004","journal-title":"Pediatrics"},{"issue":"7","key":"pone.0341580.ref034","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1111\/crj.13620","article-title":"Clinical characteristics and serum inflammatory markers of community-acquired mycoplasma pneumonia in children","volume":"17","author":"F Fan","year":"2023","journal-title":"Clin Respir J"},{"key":"pone.0341580.ref035","doi-asserted-by":"crossref","first-page":"4593","DOI":"10.2147\/IDR.S419873","article-title":"Clinical value of metagenomics next-generation sequencing in antibiotic resistance of a patient with severe refractory mycoplasma pneumoniae pneumonia: A case report","volume":"16","author":"L Lin","year":"2023","journal-title":"Infect Drug Resist"},{"issue":"6","key":"pone.0341580.ref036","doi-asserted-by":"crossref","first-page":"3000605211016376","DOI":"10.1177\/03000605211016376","article-title":"Mutations in domain V of Mycoplasma pneumoniae 23S rRNA and clinical characteristics of pediatric M. pneumoniae pneumonia in Nanjing, China","volume":"49","author":"C Xu","year":"2021","journal-title":"J Int Med Res"},{"issue":"11","key":"pone.0341580.ref037","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1002\/ppul.21481","article-title":"Combined treatment for child refractory Mycoplasma pneumoniae pneumonia with ciprofloxacin and glucocorticoid","volume":"46","author":"A Lu","year":"2011","journal-title":"Pediatr Pulmonol"},{"issue":"1","key":"pone.0341580.ref038","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1186\/s13052-022-01376-6","article-title":"Correlation between Mycoplasma pneumoniae drug resistance and clinical characteristics in bronchoalveolar lavage fluid of children with refractory Mycoplasma pneumoniae pneumonia","volume":"48","author":"X-W Zhan","year":"2022","journal-title":"Ital J Pediatr"},{"issue":"6","key":"pone.0341580.ref039","first-page":"384","article-title":"Advances in diagnosis and treatment of refractory mycoplasma pneumoniae pneumonia in children","volume":"47","author":"ting Xi S","year":"2020","journal-title":"Int J Pediatrics"},{"issue":"3","key":"pone.0341580.ref040","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1002\/ppul.20374","article-title":"Role of prednisolone treatment in severe Mycoplasma pneumoniae pneumonia in children","volume":"41","author":"K-Y Lee","year":"2006","journal-title":"Pediatr Pulmonol"},{"issue":"1","key":"pone.0341580.ref041","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s10020-019-0105-2","article-title":"High co-expression of TNF-\u03b1 and CARDS toxin is a good predictor for refractory Mycoplasma pneumoniae pneumonia","volume":"25","author":"G Li","year":"2019","journal-title":"Mol Med"},{"issue":"4","key":"pone.0341580.ref042","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1586\/14787210.6.4.509","article-title":"Pediatric respiratory infections by Mycoplasma pneumoniae","volume":"6","author":"K-Y Lee","year":"2008","journal-title":"Expert Rev Anti Infect Ther"},{"key":"pone.0341580.ref043","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.ijid.2014.07.020","article-title":"Clinical and laboratory profiles of refractory Mycoplasma pneumoniae pneumonia in children","volume":"29","author":"M Wang","year":"2014","journal-title":"Int J Infect Dis"},{"issue":"11","key":"pone.0341580.ref044","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000024894","article-title":"The risk factors of children acquiring refractory mycoplasma pneumoniae pneumonia: A meta-analysis","volume":"100","author":"H Gong","year":"2021","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"pone.0341580.ref045","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12879-020-05700-5","article-title":"Clinical significance of D-dimer levels in refractory Mycoplasma pneumoniae pneumonia","volume":"21","author":"X Huang","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0341580.ref046","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12872-022-03030-9","article-title":"Clinical characteristics of 14 pediatric mycoplasma pneumoniae pneumonia associated thrombosis: a retrospective study","volume":"23","author":"Y Fu","year":"2023","journal-title":"BMC Cardiovasc Disord"},{"issue":"18","key":"pone.0341580.ref047","first-page":"1386","article-title":"Clinical analysis and etiological discussion of 30 cases of pediatric pulmonary embolism","volume":"37","author":"F Liu","year":"2022","journal-title":"Chin J Practical Pediatrics"},{"issue":"6","key":"pone.0341580.ref048","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.21037\/tp-22-95","article-title":"Inherited and acquired causes renal vein thrombosis in an 11-year-old boy who was relieved after piperacillin-tazobactam and rivaroxaban treatment: A case report","volume":"11","author":"S Zhu","year":"2022","journal-title":"Transl Pediatr"},{"issue":"7","key":"pone.0341580.ref049","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/cir625","article-title":"The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America","volume":"53","author":"JS Bradley","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"3","key":"pone.0341580.ref050","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0173635","article-title":"Therapeutic efficacy of azithromycin, clarithromycin, minocycline and tosufloxacin against macrolide-resistant and macrolide-sensitive Mycoplasma pneumoniae pneumonia in pediatric patients","volume":"12","author":"N Ishiguro","year":"2017","journal-title":"PLoS One"},{"issue":"4","key":"pone.0341580.ref051","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.jmii.2020.10.002","article-title":"Rational stepwise approach for 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Refractory Mycoplasma pneumoniae Pneumonia in Children","volume":"10","author":"F Shen","year":"2022","journal-title":"Front Pediatr"},{"issue":"1","key":"pone.0341580.ref055","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s12931-020-01577-9","article-title":"The combination of initial markers to predict refractory Mycoplasma pneumoniae pneumonia in Chinese children: A case control study","volume":"22","author":"J Wen","year":"2021","journal-title":"Respir Res"},{"issue":"1","key":"pone.0341580.ref056","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1186\/s12931-019-1152-5","article-title":"Critical combination of initial markers for predicting refractory Mycoplasma pneumoniae pneumonia in children: A case control study","volume":"20","author":"Y-J Choi","year":"2019","journal-title":"Respir Res"},{"key":"pone.0341580.ref057","doi-asserted-by":"crossref","first-page":"1094118","DOI":"10.3389\/fped.2023.1094118","article-title":"Diagnostic value of serum LDH in children with refractory Mycoplasma pneumoniae pneumoniae: A systematic review and meta-analysis","volume":"11","author":"S Wang","year":"2023","journal-title":"Front Pediatr"},{"issue":"01","key":"pone.0341580.ref058","first-page":"43","article-title":"Analysis of risk factors for refractory mycoplasma pneumoniae pneumonia in children","volume":"39","author":"Z Yu","year":"2024","journal-title":"Clinical Synopsis"},{"issue":"3","key":"pone.0341580.ref059","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1007\/s00431-022-04761-9","article-title":"Clinical features and risk factors of plastic bronchitis caused by refractory Mycoplasma pneumoniae pneumonia in children: A practical nomogram prediction model","volume":"182","author":"H Zhang","year":"2023","journal-title":"Eur J Pediatr"},{"issue":"9","key":"pone.0341580.ref060","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.4187\/respcare.03032","article-title":"Effects of bronchoalveolar lavage on refractory 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