{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:07:53Z","timestamp":1789664873181,"version":"4.0.1"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T00:00:00Z","timestamp":1734652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p><jats:italic>Mycoplasma pneumoniae<\/jats:italic> (<jats:italic>M. pneumoniae<\/jats:italic>), a common pathogen of community-acquired pneumonia in school-age children and adolescents, can cause epidemics worldwide. In late 2023, the incidence of <jats:italic>M. pneumoniae<\/jats:italic> infection among children reached a high level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We investigated the <jats:italic>in vitro<\/jats:italic> antimicrobial susceptibility of 62 <jats:italic>M. pneumoniae<\/jats:italic> isolates obtained from children with pneumonia in Beijing between 2021 and 2023, and analyzed the correlation of antimicrobial susceptibility with molecular characteristics of isolates and clinical manifestations of patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The resistance rates of <jats:italic>M. pneumoniae<\/jats:italic> isolates against erythromycin and azithromycin were both 100% (62\/62). The minimum inhibitory concentration (MIC) of acetylspiramycin (16-membered macrolides) was lower than that of erythromycin and azithromycin. The MIC of azithromycin in 2023 was notably higher compared to 2021 and 2022. No resistance to tetracycline and levofloxacin was observed. Genotypes P1 type 1 and P1 type 2 were identified in 74.2% and 25.8% of isolates, and M4-5-7-2 (61.3%) and M3-5-6-2 (22.6%) were predominant multi-locus variable-number tandem-repeat analysis (MLVA) types. The A2063G mutation was present in all isolates (100%). Among the patients, 45\/59 cases (76.3%) had severe <jats:italic>M. pneumoniae<\/jats:italic> pneumonia, and 14\/59 cases (23.7%) presented co-infection. The duration of fever was 12 days (1-30 days) and the fever duration after initiation of macrolide antibiotics treatment was 8 days (1-22 days).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Our study showed that macrolide-resistant <jats:italic>M. pneumoniae<\/jats:italic> (MRMP) with high <jats:italic>in vitro<\/jats:italic> antimicrobial resistance level may be the causative factor of the <jats:italic>M. pneumoniae<\/jats:italic> epidemic in late 2023 in Beijing, China. It is urgent to pay more attention to MRMP and the antibiotics choose.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2024.1478087","type":"journal-article","created":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T05:10:35Z","timestamp":1734671435000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":25,"title":["Increased in vitro antimicrobial resistance of Mycoplasma pneumoniae isolates obtained from children in Beijing, China, in 2023"],"prefix":"10.3389","volume":"14","author":[{"given":"Xinyu","family":"Jia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujie","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yagang","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanqing","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanling","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanhua","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinghua","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Gan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junxia","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tongtong","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziying","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihui","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijuan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuehua","family":"Ke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanhe","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,12,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.3390\/microorganisms8091351","article-title":"Mycoplasmas-host interaction: mechanisms of inflammation and association with cellular transformation","volume":"8","author":"Benedetti","year":"2020","journal-title":"Microorganisms"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.04859-22","article-title":"Development of a serum-free medium to aid large-scale production of mycoplasma-based therapies","volume":"11","author":"Burgos","year":"2023","journal-title":"Microbiol. Spectr."},{"key":"B3","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1086\/653535","article-title":"High prevalence of macrolide resistance in Mycoplasma pneumoniae isolates from adult and adolescent patients with respiratory tract infection in China","volume":"51","author":"Cao","year":"2010","journal-title":"Clin. Infect. Dis."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1126\/science.140.3567.662","article-title":"Mycoplasma pneumoniae: proposed nomenclature for atypical pneumonia organism (Eaton agent)","volume":"140","author":"Chanock","year":"1963","journal-title":"Science"},{"key":"B5","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s13052-024-01615-y","article-title":"Efficacy of doxycycline therapy for macrolide-resistant Mycoplasma pneumoniae pneumonia in children at different periods","volume":"50","author":"Chen","year":"2024","journal-title":"Ital J. Pediatr."},{"key":"B6","first-page":"291","article-title":"Guidelines for the Diagnosis and Treatment of Mycoplasma pneumoniae in Children(2023 edition)","volume":"36","author":"Commission","year":"2023","journal-title":"Infect. Dis. Info"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1038\/d41586-023-03732-w","article-title":"What\u2019s behind China\u2019s mysterious wave of childhood pneumonia","author":"Conroy","year":"2023","journal-title":"Nature"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2024.107074","article-title":"Predominance of A2063G mutant strains in the Mycoplasma pneumoniae epidemic in children: A clinical and epidemiological study in 2023 in Wuhan, China","volume":"145","author":"Dekyi","year":"2024","journal-title":"Int. J. Infect. Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1128\/JCM.37.1.14-17.1999","article-title":"Comparison of PCR, culture, and serological tests for diagnosis of Mycoplasma pneumoniae respiratory tract infection in children","volume":"37","author":"Dorigo-Zetsma","year":"1999","journal-title":"J. Clin. Microbiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/j.mimet.2011.06.008","article-title":"Culture-independent multi-locus variable-number tandem-repeat analysis (MLVA) of Mycoplasma pneumoniae","volume":"86","author":"Dumke","year":"2011","journal-title":"J. Microbiol. Methods"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2300704","DOI":"10.2807\/1560-7917.Es.2024.29.2.2300704","article-title":"Increase of respiratory illnesses among children in Beijing, China, during the autumn and winter of 2023","volume":"29","author":"Gong","year":"2024","journal-title":"Euro Surveill"},{"key":"B12","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.jgar.2022.01.002","article-title":"Molecular features and antimicrobial susceptibility of Mycoplasma pneumoniae isolates from pediatric inpatients in Weihai, China: Characteristics of M. pneumoniae In Weihai","volume":"28","author":"Guo","year":"2022","journal-title":"J. Glob Antimicrob. Resist."},{"key":"B13","doi-asserted-by":"publisher","first-page":"186","DOI":"10.7883\/yoken.JJID.2015.054","article-title":"Regional Differences in Prevalence of Macrolide Resistance among Pediatric Mycoplasma pneumoniae Infections in Hokkaido, Japan","volume":"69","author":"Ishiguro","year":"2016","journal-title":"Jpn J. Infect. Dis."},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2020.00385","article-title":"Periodic genotype shifts in clinically prevalent mycoplasma pneumoniae strains in Japan","volume":"10","author":"Kenri","year":"2020","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.20949","article-title":"Global trends in the proportion of macrolide-resistant mycoplasma pneumoniae infections: A systematic review and meta-analysis","volume":"5","author":"Kim","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"B16","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1080\/14787210.2018.1414599","article-title":"Antimicrobial therapy of macrolide-resistant Mycoplasma pneumoniae pneumonia in children","volume":"16","author":"Lee","year":"2018","journal-title":"Expert Rev. Anti Infect. Ther."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.3201\/eid2408.180081","article-title":"Clonal expansion of macrolide-resistant sequence type 3 mycoplasma pneumoniae, South Korea","volume":"24","author":"Lee","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"B18","doi-asserted-by":"publisher","first-page":"160","DOI":"10.3947\/ic.2018.50.2.160","article-title":"Guideline for antibiotic use in adults with community-acquired pneumonia","volume":"50","author":"Lee","year":"2018","journal-title":"Infect. Chemother."},{"key":"B19","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.jinf.2022.12.030","article-title":"Changes of Mycoplasma pneumoniae prevalence in children before and after COVID-19 pandemic in Henan, China","volume":"86","author":"Li","year":"2023","journal-title":"J. Infect."},{"key":"B20","doi-asserted-by":"publisher","first-page":"5026","DOI":"10.1038\/s41467-021-25120-6","article-title":"Etiological and epidemiological features of acute respiratory infections in China","volume":"12","author":"Li","year":"2021","journal-title":"Nat. Commun."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0137354","article-title":"Comparative \u201c-omics\u201d in mycoplasma pneumoniae clinical isolates reveals key virulence factors","volume":"10","author":"Lluch-Senar","year":"2015","journal-title":"PloS One"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2770","DOI":"10.1128\/aac.39.12.2770","article-title":"Transition mutations in the 23S rRNA of erythromycin-resistant isolates of Mycoplasma pneumoniae","volume":"39","author":"Lucier","year":"1995","journal-title":"Antimicrob. Agents Chemother."},{"key":"B23","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1111\/cei.13510","article-title":"Mycoplasma pneumoniae lipids license TLR-4 for activation of NLRP3 inflammasome and autophagy to evoke a proinflammatory response","volume":"203","author":"Luo","year":"2021","journal-title":"Clin. Exp. Immunol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1736","DOI":"10.1128\/aac.02011-12","article-title":"Blood, tissue, and intracellular concentrations of azithromycin during and after end of therapy","volume":"57","author":"Matzneller","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"B25","doi-asserted-by":"publisher","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the american thoracic society and infectious diseases society of america","volume":"200","author":"Metlay","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/s2666-5247(23)00344-0","article-title":"Mycoplasma pneumoniae: delayed re-emergence after COVID-19 pandemic restrictions","volume":"5","author":"Meyer Sauteur","year":"2023","journal-title":"Lancet Microbe"},{"key":"B27","doi-asserted-by":"publisher","first-page":"12s","DOI":"10.1016\/0002-9343(91)90395-e","article-title":"Clinical microbiology of azithromycin","volume":"91","author":"Neu","year":"1991","journal-title":"Am. J. Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"2428","DOI":"10.3390\/microorganisms10122428","article-title":"Recent Trend of Antimicrobial Susceptibility among Mycoplasma pneumoniae Isolated from Japanese Children","volume":"10","author":"Oishi","year":"2022","journal-title":"Microorganisms"},{"key":"B29","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1001\/jama.2019.21118","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia","volume":"323","author":"Olson","year":"2020","journal-title":"Jama"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0082174","article-title":"Specific multilocus variable-number tandem-repeat analysis genotypes of Mycoplasma pneumoniae are associated with diseases severity and macrolide susceptibility","volume":"8","author":"Qu","year":"2013","journal-title":"PloS One"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.01663-17","article-title":"Mycoplasma pneumoniae community-acquired respiratory distress syndrome toxin uses a novel KELED sequence for retrograde transport and subsequent cytotoxicity","volume":"9","author":"Ramasamy","year":"2018","journal-title":"mBio"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1186\/s12879-024-10070-3","article-title":"New-generation tetracyclines for severe macrolide-resistant Mycoplasma pneumoniae pneumonia in children: a retrospective analysis","volume":"24","author":"Song","year":"2024","journal-title":"BMC Infect. Dis."},{"key":"B33","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1183\/09031936.04.00084304","article-title":"Azithromycin for cystic fibrosis","volume":"24","author":"Southern","year":"2004","journal-title":"Eur. Respir. J."},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2021.766591","article-title":"Community-acquired respiratory distress syndrome toxin: unique exotoxin for M. pneumoniae","volume":"12","author":"Su","year":"2021","journal-title":"Front. Microbiol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e64607","DOI":"10.1371\/journal.pone.0064607","article-title":"Multiple-locus variable-number tandem-repeat analysis of mycoplasma pneumoniae clinical specimens and proposal for amendment of MLVA nomenclature","volume":"8","author":"Sun","year":"2013","journal-title":"PloS One"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0170253","article-title":"Changes in molecular characteristics of mycoplasma pneumoniae in clinical specimens from children in beijing between 2003 and 2015","volume":"12","author":"Sun","year":"2017","journal-title":"PloS One"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00968-19","article-title":"Macrolide-resistant mycoplasma pneumoniae in the United States as determined from a national surveillance program","volume":"57","author":"Waites","year":"2019","journal-title":"J. Clin. Microbiol."},{"key":"B38","doi-asserted-by":"publisher","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":"Waites","year":"2004","journal-title":"Clin. Microbiol. Rev."},{"key":"B39","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1128\/cmr.00114-16","article-title":"Mycoplasma pneumoniae from the respiratory tract and beyond","volume":"30","author":"Waites","year":"2017","journal-title":"Clin. Microbiol. Rev."},{"key":"B40","volume-title":"Methods for antimicrobial susceptibility testing for human mycoplasmas; approved guideline","author":"Waites","year":"2011"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.675466","article-title":"Increased macrolide resistance rate of M3562 mycoplasma pneumoniae correlated with macrolide usage and genotype shifting","volume":"11","author":"Wang","year":"2021","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.578824","article-title":"In vitro activity of lefamulin against the common respiratory pathogens isolated from mainland China during 2017-2019","volume":"11","author":"Wu","year":"2020","journal-title":"Front. Microbiol."},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00710-20","article-title":"Molecular characterization of mycoplasma pneumoniae isolates in the United States from 2012 to 2018","volume":"58","author":"Xiao","year":"2020","journal-title":"J. Clin. Microbiol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12519-023-00783-x","article-title":"Current status of Mycoplasma pneumoniae infection in China","volume":"20","author":"Yan","year":"2024","journal-title":"World J. Pediatr."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1002\/ppul.24327","article-title":"Molecular and clinical characteristics of severe Mycoplasma pneumoniae pneumonia in children","volume":"54","author":"Yan","year":"2019","journal-title":"Pediatr. Pulmonol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1016\/j.jmii.2023.01.010","article-title":"The clinical significance of and the factors associated with macrolide resistance and poor macrolide response in pediatric Mycoplasma pneumoniae infection: A retrospective study","volume":"56","author":"Yen","year":"2023","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1016\/j.xphs.2024.01.012","article-title":"Population pharmacokinetics and individualized medication of azithromycin for injection in children under 6 years old","volume":"113","author":"Zhang","year":"2024","journal-title":"J. Pharm. Sci."},{"key":"B48","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1186\/s13756-019-0576-5","article-title":"Antimicrobial susceptibility and molecular characteristics of Mycoplasma pneumoniae isolates across different regions of China","volume":"8","author":"Zhao","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-019-0469-7","article-title":"Antimicrobial susceptibility and genotyping of Mycoplasma pneumoniae isolates in Beijing, China, from 2014 to 2016","volume":"8","author":"Zhao","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0141702","article-title":"Culture-independent detection and genotyping of mycoplasma pneumoniae in clinical specimens from beijing, China","volume":"10","author":"Zhao","year":"2015","journal-title":"PloS One"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1128\/aac.00686-18","article-title":"Population pharmacokinetics and dosing optimization of azithromycin in children with community-acquired pneumonia","volume":"62","author":"Zheng","year":"2018","journal-title":"Antimicrob. Agents Chemother."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2024.1478087\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T05:10:39Z","timestamp":1734671439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2024.1478087\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,20]]},"references-count":51,"alternative-id":["10.3389\/fcimb.2024.1478087"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2024.1478087","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,20]]},"article-number":"1478087"}}