{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T18:14:23Z","timestamp":1773425663581,"version":"3.50.1"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wei Gong Memorial Hospital","award":["WMH-114-006"],"award-info":[{"award-number":["WMH-114-006"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: To date, no study has compared the clinical characteristics of Mycoplasma pneumoniae-associated segmental\/lobar pneumonia, Mycoplasma bronchopneumonia, and COVID-19 pneumonia primarily caused by the NB.1.8.1 variant in children. Methods: We examined the epidemiologic trends of pneumonia, segmental\/lobar pneumonia, and COVID-19 pneumonia at a teaching hospital from 2015 to 2025. In addition, we compared the clinical characteristics of children hospitalized with Mycoplasma segmental\/lobar pneumonia, Mycoplasma bronchopneumonia, and COVID-19 pneumonia during the NB.1.8.1 variant wave in 2024\u20132025. Results: Between 2015 and 2024, 10,601 pneumonia cases were identified, including 525 cases of segmental\/lobar pneumonia and 162 cases of COVID-19 pneumonia. An outbreak of segmental\/lobar M. pneumoniae pneumonia and COVID-19 pneumonia occurred in Taiwan during 2024\u20132025. Starting in early 2025, monthly Mycoplasma positivity rates among children with segmental\/lobar pneumonia and bronchopneumonia exceeded 60%. Mycoplasma pneumonia predominantly affected children aged 6\u201311 years, whereas COVID-19 pneumonia mainly occurred in those younger than 3 years of age. Fever, cough, and rhinorrhea were the most common symptoms in all groups, limiting clinical differentiation. Children with segmental\/lobar Mycoplasma pneumonia were more likely to present with prolonged fever (&gt;5 days), lymphocytopenia, a neutrophil-to-lymphocyte ratio (NLR) \u2265 3, and elevated C-reactive protein (CRP) levels, each of which was strongly associated with macrolide non-response (all p &lt; 0.001). Conclusions: Children with segmental\/lobar Mycoplasma pneumonia demonstrated more severe clinical manifestations. Segmental\/lobar involvement and inflammatory markers, such as lymphocytopenia, elevated NLR, and increased CRP levels, were associated with macrolide non-response. These indicators may help guide therapeutic decision-making in pediatric M. pneumoniae pneumonia.<\/jats:p>","DOI":"10.3390\/antibiotics15030292","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T17:36:48Z","timestamp":1773423408000},"page":"292","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Emergence of Clinically Macrolide-Unresponsive Mycoplasma pneumoniae Segmental\/Lobar Pneumonia and COVID-19 Pneumonia in Children in Taiwan, 2024\u20132025"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7401-856X","authenticated-orcid":false,"given":"Hao-Yuan","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan"},{"name":"Department of Pediatrics, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"},{"name":"School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 242062, Taiwan"},{"name":"Division of Pediatric Infectious Diseases, China Medical University Children\u2019s Hospital, China Medical University, Taichung 40447, Taiwan"},{"name":"Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chien-Chin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8313-7070","authenticated-orcid":false,"given":"Shu-Hua","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Ling","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"En-Pen","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng-Yi","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia Ru","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Hsin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Chau","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meng-Yen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Lung","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, China Medical University Children\u2019s Hospital, China Medical University, Taichung 40447, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Yuan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"},{"name":"Division of Pediatric Infectious Diseases, China Medical University Children\u2019s Hospital, China Medical University, Taichung 40447, Taiwan"},{"name":"Department of Neurosurgery, China Medical University Children\u2019s Hospital, China Medical University, Taichung 40447, Taiwan"},{"name":"Department of Neurosurgery, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chyi-Liang","family":"Chen","sequence":"additional","affiliation":[{"name":"Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan"},{"name":"Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Alexopoulou, E., Prountzos, S., Raissaki, M., Mazioti, A., Caro-Dominguez, P., Hirsch, F.W., Lovrenski, J., and Ciet, P. 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