Mycoplasma pneumoniae is currently the most commonly detected bacterial cause of childhood community-acquired pneumonia in several countries. Of note, clonal expansion of macrolide-resistant ST3 occurred in Japan and South Korea. An alarming surge in macrolide resistance complicated the treatment of pneumonia. We aimed to evaluate the clinical manifestation and the clonal relatedness of M. pneumoniae circulating among children in Taiwan.
We prospectively enrolled 626 children with radiologically confirmed pneumonia between 2017 and 2019. M. pneumoniae infection was suspected on clinical grounds, and tested by real-time polymerase chain reaction and oropharyngeal swab cultures. We used multi-locus sequence typing and whole-genome sequencing to characterize the genetic features of M. pneumoniae.
A total of 226 children with M. pneumoniae pneumonia were enrolled. Macrolide resistance was found in 77% (174/226) patients. Multi-locus sequence typing revealed that ST3 (n=93) and its single-locus variant ST17 (n=84) were the predominant clones among macrolide-resistant strains. ST17 presented clinical characteristics comparable to its ancestor ST3. On multivariate analysis, macrolide resistance (OR, 3.5; 95%IC, 1.4-8.5; P=0.007) was independently associated with fever >72 hours after macrolide treatment. By whole genome sequencing, prediction analysis of recombination sites revealed one recombination site in ST3 and ST17 compared with M29 (a macrolide-sensitive ST3 strain isolated from China in 2005))containing cytadhesin MgpC-like protein, RepMP4, and RepMP5. ST17 had another recombination site containing an adhesin and RepMP2/3.
In addition to macrolide resistance, ST3 and its ST17 variant might evolve through recombination between repetitive sequences and non-P1 cytadhesins for persistent circulation in Taiwan.

Copyright © 2020. Published by Elsevier Ltd.