title: Clinical outcomes and macrolide resistance in Mycoplasma pneumoniae infection in Scotland, UK.
abstract: Mycoplasma pneumoniae has a cyclical, epidemic pattern of infection and the most recent epidemic occurred in Europe in 2011. Macrolides are recommended for the treatment of M. pneumoniae respiratory tract infection, but macrolide resistance has been reported at low levels in Europe. The aim of the study was to examine the clinical impact of the recent M. pneumoniae epidemic in a hospital setting in Scotland and to determine whether macrolide-resistant strains are present. Data were analysed retrospectively for 307 patients with M. pneumoniae respiratory infection diagnosed in 2010 and 2011 in Edinburgh, UK. Genotypic macrolide resistance testing was also carried out in 32 patients in whom resistance was considered most likely, based on their clinical picture. We found that 175 patients (59 %) were admitted to hospital, 20 (7 %) were admitted to critical care and 97 (38 %) required oxygen. All 48 adult patients (100 %) were admitted to hospital, compared with 127 children (51 %). Adults were also more likely to require oxygen [odds ratio (OR) 4.964, P<0.001, 95 % confidence interval (CI) 2.129-11.803] and to be admitted to critical care (OR 4.909, P = 0.001, 95 % CI 1.735-13.829), compared with children. Macrolide resistance conferred by the 23S rRNA gene mutation was found in samples from 6 out of 32 patients (19 %) in the subset tested. The results suggest that the recent M. pneumoniae epidemic was associated with a significant burden of hospital admission locally. The study also describes the first case series of macrolide-resistant M. pneumoniae in the UK, indicating that macrolide resistance surveillance is warranted in preparation for the next epidemic.
authors.affiliation: Specialist Virology Centre, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Graeme D
authors.initials: GD
authors.lastname: Ferguson
authors.affiliation: Specialist Virology Centre, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Gadsby
authors.affiliation: Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Henderson
authors.affiliation: Specialist Virology Centre, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Hardie
authors.affiliation: Medical Microbiology, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Pota
authors.initials: P
authors.lastname: Kalima
authors.affiliation: University of Edinburgh/Medical Research Council Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK.
authors.forename: Andrew Conway
authors.initials: AC
authors.lastname: Morris
authors.affiliation: Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Hill
authors.affiliation: Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Cunningham
authors.affiliation: Specialist Virology Centre, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Templeton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000235:genetics; D024881:Drug Resistance, Bacterial; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009175:Mycoplasma Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D009177:Mycoplasma pneumoniae / Q000187:drug effects* / Q000235:genetics*; D011019:Pneumonia, Mycoplasma / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D012338:RNA, Ribosomal, 23S / Q000235:genetics; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D018942:Macrolides; D012338:RNA, Ribosomal, 23S