{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:06:46Z","timestamp":1791576406893,"version":"4.3.4"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"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:p>\n                    <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                    is one of the most significant pathogens responsible for\nrespiratory infections in humans. Macrolides are recommended as the first-line treatment for\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    infection. The prevalence of macrolide-resistant\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    has increased significantly in recent decades, particularly in China. The mechanisms of resistance in\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    to macrolides have been extensively studied in pediatric patients. However, a paucity reports regarding the resistance characteristics and mechanisms exhibited in adults. The aim of this study was to elucidate the resistance of\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    to macrolides and the underlying mechanisms in adult patients. Pharyngeal swab specimens were collected from adult patients presenting with subacute cough or community-acquired pneumonia at our hospital from January 2011 to June 2017 to identify and isolate\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    strains. The antimicrobial susceptibility of these isolates to 3 macrolide antibiotics was assessed using broth microdilution method. The\n                    <jats:italic>23S rRNA<\/jats:italic>\n                    genes of macrolide-resistant\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    strains were sequenced, and the presence of target methylation genes (\n                    <jats:italic>ermA<\/jats:italic>\n                    ,\n                    <jats:italic>ermB<\/jats:italic>\n                    , and\n                    <jats:italic>ermC<\/jats:italic>\n                    ), efflux pump genes (\n                    <jats:italic>mefA<\/jats:italic>\n                    ,\n                    <jats:italic>mefA\/E<\/jats:italic>\n                    ,\n                    <jats:italic>msrA<\/jats:italic>\n                    , and\n                    <jats:italic>msrA\/B<\/jats:italic>\n                    ), and the macrolide resistance gene\n                    <jats:italic>mphC<\/jats:italic>\n                    was identified through polymerase chain reaction (PCR) testing. Additionally, MICs were determined with and without the efflux pump inhibitor reserpine. A total of 72\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    strains were isolated from adult patients, with 41.7% (30\/72) exhibiting macrolide resistance. Among the 3 macrolides tested, the 16-membered-ring midecamycin exhibited the greatest activity (MIC\n                    <jats:sub>90<\/jats:sub>\n                    : 16 \u00b5g\/ml) against\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    . All macrolide-resistant\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    strains harbored mutations at the 2063 site in domain V of the\n                    <jats:italic>23S rRNA<\/jats:italic>\n                    gene. Two macrolide-resistant\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    clinical isolates were found to harbor the efflux pump genes\n                    <jats:italic>msrA\/B<\/jats:italic>\n                    and\n                    <jats:italic>mefA<\/jats:italic>\n                    . The efflux pump inhibitor reserpine reduced the MIC for azithromycin in these two strains to a quarter of their original values. In summary, macrolide-resistant\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    is commonly observed among adults in Beijing. Point mutations are the primary mechanism responsible for macrolide resistance in adults with\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    . Additionally, the efflux pump mechanism may contribute partially to this resistance. Midecamycin presents a promising alternative drug for treating\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    infections, particularly in cases of azithromycin-resistant\n                    <jats:italic>M. pneumoniae<\/jats:italic>\n                    infection in young children.\n                  <\/jats:p>","DOI":"10.3389\/fcimb.2025.1496521","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T02:11:10Z","timestamp":1741054270000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["Macrolide resistance in Mycoplasma pneumoniae in adult patients"],"prefix":"10.3389","volume":"15","author":[{"given":"Panpan","family":"Xie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhong","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunbiao","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimeng","family":"Zhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenkai","family":"Niu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fusheng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"259","DOI":"10.37201\/req\/118.2022","article-title":"Macrolide-resistant Mycoplasma pneumoniae: Do we know the situation in Europe]","volume":"36","author":"\u00c1lvaro Varela","year":"2023","journal-title":"Rev. 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