Macrolide-Resistant Mycoplasma pneumoniae Infection Rates High in Children, Western Pacific Region

Lung infection caused by bacteria Mycoplasma pneumoniae, 3D illustration. Bacterial pneumonia medical concept
Researchers assessed temporal and regional trends to estimate the global rate of macrolide-resistant Mycoplasma pneumoniae infections.

Results of a systematic review and meta-analysis published in JAMA Network Open found that the global rate of macrolide-resistant Mycoplasma pneumoniae (MRMP) infections has increased, highlighting the need for effective strategies to decrease the burden of MRMP infection.

Researchers from universities in South Korea searched publication databases through September 2021 for observational studies that assessed MRMP infection rates. The researchers estimated the global rate of MRMP infections and investigated temporal trends and MRMP variant types among studies conducted in different geographic regions defined by the World Health Organization.

A total of 150 studies were included in the analysis, of which 54.9% included children, 9.8% included adults, 22.9% included both children and adults, and 12.4% did not record the ages of the included patients. The included studies were conducted in the Western Pacific (67.3%), European (20.3%), American (9.2%), Southeast Asian (2.0%), and Eastern Mediterranean (1.3%) regions.

Between 2000 and 2010, the global rate of MRMP infections increased from 18.2% to 41.0%, followed by an additional increase to 76.5% in 2019 (P <.001 for trend). Stratified by region, the increase in the rate of MRMP infections during this period was significant only in the West Pacific (P =.01), with no significant changes noted among the other regions.

The highest rate of MRMP infection was observed in the West Pacific (53.4%), followed by Southeast Asia (9.8%), the Americas (8.4%), Europe (5.1%), and the East Mediterranean region (1.4%).

Within the Western Pacific region, the highest rate of MRMP infections was observed in China (79.5%), followed by Japan (47.3%) and Taiwan (32.4%), with the lowest rate observed in Australia (1.5%).

Stratified by patient age, the rate of MRMP infections was increased in studies conducted among only children (37.0%; 95% CI, 29.8-46.1) compared with those conducted among only adults (15.9%; 95% CI, 6.4-39.7).

Of all included studies, the most commonly isolated resistant variant among patients with MRMP infection was A2063G (96.8%), followed by A2064G (4.8%).

This study was limited by significant heterogeneity, and its findings may not be generalizable among all regions as most studies were conducted in the Western Pacific region and no data from Africa were included in the analysis.

According to the researchers, “the results of the present study provide helpful information on the proportion of MRMP infections and may be used to overcome the disease burden of MRMP infections via the establishment of appropriate therapeutic strategies.”


Kim K, Jung S, Kim M, Park S, Yang H-J, Lee E. Global trends in the proportion of macrolide-resistant mycoplasma pneumoniae infections: a systematic review and Meta-analysis. JAMA Netw Open. 2022;5(7):e2220949. doi:10.1001/jamanetworkopen.2022.20949