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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Comprehensive study of community acquired Mycoplasma pneumoniae pneumonia in children in Baoding, China, 2023
Jing Bi, Xu Li, He Tang, Olga Kalinina, Ting-Ting Jiang, Wei-Wei Jiao, Xi Zeng, Alexander Dmitriev, Adong Shen
Jing Bi, He Tang, Ting-Ting Jiang, Alexander Dmitriev, Adong Shen, Baoding Key Laboratory for Precision Diagnosis and Treatment of Infectious Diseases in Children, Hebei Key laboratory of Infectious Diseases Pathogenesis and Precise Diagnosis and Treatment, Baoding Hospital of Beijing Children’s Hospital, Capital Medical University, Baoding 071000, Hebei Province, China
Xu Li, Wei-Wei Jiao, Xi Zeng, Adong Shen, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Laboratory of Respiratory Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 10045, China
Olga Kalinina, Department of Laboratory Medicine with Clinic, Institution of Medical Education, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
Olga Kalinina, Laboratory of Molecular Epidemiology and Evolutionary Genetics, Saint-Petersburg Pasteur Institute, Saint Petersburg 197021, Russia
Alexander Dmitriev, Department of Molecular Biotechnology, Saint-Petersburg State Institute of Technology, Saint Petersburg 190013, Russia
Co-corresponding authors: Alexander Dmitriev and Adong Shen.
Author contributions: Bi J interpreted the data, provided clinical advice, drafted the initial manuscript; Li X contributed to the data collection process and formal analysis; Tang H, Jiang TT collected the data, provided clinical advice; Kalinina O participated in data analysis and interpretation; Jiao WW and Zeng X participated in data collection and editing the manuscript; Shen A contributed to project administration; Dmitriev A and Shen A conceptualized the study, analyzed and interpreted the data, drafted the initial manuscript; all Authors contributed to manuscript editing and approved the final version of the manuscript.
Supported by Baoding Science and Technology Plan Project, No. 2272P011; Hebei Province Scientific Research Project, No. 20241734; and Hebei Natural Science Foundation Project, No. H2024104011.
Institutional review board statement: The study was approved by the Ethics Committee of Baoding Hospital of Beijing Children’s Hospital, Capital Medical University (protocol N 2025-19).
Informed consent statement: Written informed consent was obtained from the participants’ legal guardian/next of kin.
Conflict-of-interest statement: Dr. Shen reports grants from Baoding Science and Technology Institute, grants from Hebei Province Science and Technology Institute, grants from Hebei Natural Science Foundation, during the conduct of the study.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Adong Shen, Professor, National Clinical Medical Research Center for Respiratory Diseases, Capital Medical University, Beijing Children's Hospital, Beijing Institute of Pediatrics, No. 56 Nan Li Shi Rd, Beijing 100045, China.
shenad16@hotmail.com
Received: April 9, 2025
Revised: May 8, 2025
Accepted: August 1, 2025
Published online: December 9, 2025
Processing time: 211 Days and 5.4 Hours
BACKGROUND
Mycoplasma pneumoniae (M. pneumoniae) is considered to be one of the causative agents of community acquired pneumonia in children with general or severe course of disease. Severe M. pneumoniae pneumonia (SMPP) has emerged as a crucial global health concern due to high mortality rate in children under 5 years, potentially life-threatening complications, and growing challenges in pediatric treatment associated with rising macrolide resistance. Additionally, MPP can be complicated by other bacterial and/or viral pathogens, which may exacerbate disease severity. After the lifting of strict non-pharmaceutical interventions (NPIs) worldwide, the dramatic rise of incidence of MPP in Asia and Europe was observed.
AIM
To perform the comprehensive study of community acquired MPP cases registered in 2023 in Baoding Hospital, China.
METHODS
A total of 1160 children from 1 month to 15 years old with confirmed MPP diagnosis were enrolled in the study. The blood and respiratory samples were collected within the 24 hours after admission. The hematological parameters, biochemical markers, cytokine profiles were assessed. The respiratory samples were tested for the presence of M. pneumoniae and other 23 bacterial/viral pathogens by multiplex polymerase chain reaction (PCR). The macrolide resistance mutations (A2063G, A2064G in the 23S rRNA gene of M. pneumoniae) were determined by PCR.
RESULTS
Number of MPP cases has dramatically increased starting August with peak in November. SMPP and general MPP (GMPP) were identified in 264 and 896 of 1160 hospitalized children. The binary logistic regression analysis identified six [C-reactive protein (CRP), lactate dehydrogenase, procalcitonin, erythrocyte sedimentation rate, fibrin and fibrinogen degradation products (FDPs), D-dimer] and four (neutrophils, CRP, FDPs, prothrombin time) predictors of SMPP in age groups 2-5 years and 6-15 years, respectively. Children with SMPP showed significantly higher levels of cytokine interleukin (IL)-17F (2-5 years), and cytokines interferon-gamma, tumor necrosis factor-alpha, IL-10 (6-13 years). Concomitant viral/bacterial pathogens were determined in 24.3% and 28.0% cases of SMPP and GMPP. Among them, Streptococcus pneumoniae (S. pneumoniae) and Haemophilus influenzae (H. influenzae) were predominant. 93.2% cases of MPP were associated with macrolide resistant M. pneumoniae.
CONCLUSION
Specific MPP epidemiological pattern associated with lifting NPIs was revealed: Increase of hospitalized cases, prevalence of S. pneumoniae and H. influenzae among concomitant pathogens, 93.2% of macrolide resistant M. pneumonia.
Core Tip: After the lifting of strict non-pharmaceutical interventions (NPIs), the dramatic rise of Mycoplasma pneumoniae pneumonia (MPP) incidence in Europe and Asia was observed. Comprehensive study of community acquired cases of MPP in 2023 in Baoding Hospital, China, was performed. The dramatic increase in the incidence of MPP cases, that was delayed for nine months after lifting NPIs, and unprecedented 93.2% prevalence of macrolide resistant Mycoplasma pneumoniae causing pneumonia in children were revealed. We hypothesized that strict NPIs may have created the “bottleneck” selecting the most successful bacterial clone(s) that subsequently spread, and it may represent a “founder effect”.
