Epidemiological Characteristics and Clinical Impact of Macrolide‐Resistant Mycoplasma pneumoniae Infection in Children in Southwest China, 2021–2025

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Abstract
Background: Mycoplasma pneumoniae (MP) is a key pathogen causing pediatric community‐acquired pneumonia. Increasing macrolide resistance poses considerable clinical challenges. This study investigated MP epidemiology and macrolide resistance in children aged 0–14 years in Southwest China from 2021–2025. Methods: Retrospective analysis of MP antibody, nucleic acid, and resistance gene detection data. MP infections were categorized into macrolide‐resistant (MRMP) and macrolide‐sensitive (MSMP) groups. Clinical information was collected and compared. Results: Positive rates for MP‐RNA, DNA, IgM, and total antibodies were 12.43%, 9.82%, 30.19%, and 49.82%, respectively. Infections predominantly affected children aged 2–8 years. The macrolide resistance rate was 87.87%. Compared with the MSMP group, the MRMP group had longer hospital stays (+0.74 days), higher rates of fiberoptic bronchoscopy (+19.6%), and a significantly higher initial macrolide treatment failure rate, leading to increased doxycycline use (+20.8%). Conclusion: MRMP infections are highly prevalent in Southwest China and are associated with more complex clinical conditions and worse outcomes. Early resistance gene detection is recommended for hospitalized children with suspected MP infection during epidemic seasons. For children aged 2–8 years with persistent high fever and imaging findings of lung consolidation or mucus plugs, high suspicion of MRMP is warranted, and timely fiberoptic bronchoscopy should be considered.

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