Clinical Features and Management Strategies in Children With Mycoplasma Pneumoniae

Objective: Mycoplasma pneumoniae (Mp) is the most detected bacterial pathogen in children with community-acquired pneumonia (CAP). Our primary objective was to compare the clinical presentation, clinical management, and outcomes of children with and without Mp CAP across 6 children’s hospitals. Methods: Eligible children were 2 months old or above and diagnosed with CAP in a prospective multicenter cohort study between October 1, 2015 and June 31, 2018. Children were excluded if they had complex chronic conditions. Children were tested for Mp via polymerase chain reaction assays. Clinical outcomes included hospitalization, and among hospitalized children length of stay, pediatric intensive care unit (PICU) admission, and rehospitalization within 8 weeks of discharge. Negative binomial and logistic regression were performed to determine the association of Mp with clinical outcomes. Results: Of the 415 children included, 38 (7.4%) had Mp detected. Children with Mp were older [median interquartile range age 8.8 (3.1, 13.0) vs. 4.6 (interquartile range: 2, 8.2) y], more likely to receive azithromycin (68.4% vs. 22.2%) and more likely to receive antibiotics in the prior 2 weeks (63.2% vs. 35.7%) versus those with non-Mp CAP. Children with Mp CAP were 33% less likely to stay in the hospital for an additional day (95% CI: 0.48-0.94). Conclusion: Children with Mp CAP are more likely to have a longer duration of symptoms, but there are no statistical differences in symptom prevalence, laboratory values, or radiographic findings. There was no statistical difference in clinical outcomes for children with Mp CAP suggesting that clinical presentation and outcomes are similar between Mp and non-Mp CAP. Polymerase chain reaction testing for Mp CAP may be the only way to discriminate between non-Mp and Mp CAP.