Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

Background Mycoplasma pneumoniae(M.pneumoniae)is a significant contributor to community-acquired pneumonia among children.Since 1968,when a strain of M.pneumoniae resistant to macrolide antibiotics was initially reported in Japan,macrolide-resistant M.pneumoniae(MRMP)has been documented in many countries worldwide,with varying incidence rates.MRMP infections lead to a poor response to macrolide antibiotics,frequently resulting in prolonged fever,extended antibiotic treatment,increased hospitalization,intensive care unit admissions,and a significantly higher proportion of patients receiving glucocorticoids or second-line antibiotics.Since 2000,the global incidence of MRMP has gradually increased,especially in East Asia,which has posed a serious challenge to the treatment of M.pneumoniae infections in children and attracted widespread attention from pediatricians.However,there is still no global consensus on the diagnosis and treatment of MRMP in children.Methods We organized 29 Chinese experts majoring in pediatric pulmonology and epidemiology to write the world’s first consensus on the diagnosis and treatment of pediatric MRMP pneumonia,based on evidence collection.The evidence searches and reviews were conducted using electronic databases,including PubMed,Embase,Web of Science,CNKI,Medline,and the Cochrane Library.We used variations in terms for“macrolide-resistant”,“Mycoplasma pneumoniae”,“MP”,“M.pneumoniae”,“pneumonia”,“MRMP”,“lower respiratory tract infection”,“Mycoplasma pneumoniae infection”,“children”,and“pediatric”.Results Epidemiology,pathogenesis,clinical manifestations,early identification,laboratory examination,principles of antibiotic use,application of glucocorticoids and intravenous immunoglobulin,and precautions for bronchoscopy are highlighted.Early and rapid identification of gene mutations associated with MRMP is now available by polymerase chain reaction and fluorescent probe techniques in respiratory specimens.Although the resistance rate to macrolide remains high,it is fortunate that M.pneumoniae still maintains good in vitro sensitivity to second-line antibiotics such as tetracyclines and quinolones,making them an effective treatment option for patients with initial treatment failure caused by macrolide antibiotics.Conclusions This consensus,based on international and national scientific evidence,provides scientific guidance for the diagnosis and treatment of MRMP in children.Further studies on tetracycline and quinolone drugs in children are urgently needed to evaluate their effects on the growth and development.Additionally,developing an antibiotic rotation treatment strategy is necessary to reduce the prevalence of MRMP strains.

Associations of early-life factors and indoor environmental exposure with asthma among children:a case-control study in Chongqing,China

Background Childhood asthma has substantial effects on children’s health.It is important to identify influencing factors in early life in the development of childhood asthma.We aim to evaluate the effects of early-life factors and indoor environmental exposure on childhood asthma in Chongqing,China.Method We designed a case-control study to enrol children with asthma aged 3 to<14 years old and controls in Chongqing,China.The“Children’s Early Life and Indoor Environment Survey”was used to collect the early-life factors and indoor environmental exposure of foetuses in utero and of infants during the first 3 years of life.A multivariate logistic regression model was used to evaluate the association between independent variables and childhood asthma and the interaction of early-life factors and environmental exposure.Results A total of 160 asthma cases and 247 controls were included in this study.The mean ages of the cases and controls were 5.53±1.88 and 5.72±2.34 years,respectively(P=0.192).Early-life factors and indoor environmental exposure were independently associated with childhood asthma.Infectious diseases of the respiratory system in children under 3 years old[adjusted odds ratio(OR)=5.76,95%confidence interval(CI)2.49-13.30],bedroom air conditioner use(adjusted OR=4.61,95%CI 1.45-14.64),and bedroom dampness/mould(adjusted OR=2.98,95%CI 1.54-5.75)ranked as the three most significant exposures associated with the risk of childhood asthma.Other factors associated with an increased risk of childhood asthma included second-hand smoke exposure in early life(adjusted OR=1.93,95%CI 1.24-3.00),neonatal pneumonia(adjusted OR=1.90,95%CI 1.05-3.42)and maternal allergic diseases during pregnancy(adjusted OR=2.13,95%CI 1.10-4.10).The interaction effects of child second-hand smoke exposure with other covariates were not found to be statistically significant.Conclusions Early-life factors and indoor environmental exposure are closely related to childhood asthma in Chongqing,China.Further interventions and management in the early life of children should be considered to prevent and control childhood asthma in Chongqing and similar cities.

Publishing clinical prActice GuidelinEs(PAGE):Recommendations from editors and reviewers

Transparency Ecosystem for Research and Journals in Medicine(TERM)working group summarized the essential recommendations that should be considered to review and publish a high-quality guideline.These recommendations from editors and reviewers included 10 components of essential requirements:systematic review of existing relevant guidelines,guideline registration,guideline protocol,stakeholders,conflicts of interest,clinical questions,systematic reviews,recommendation consensus,guideline reporting and external review.TERM working group abbreviates them as PAGE(essential requirements for Publishing clinical prActice GuidelinEs),and recommends guideline authors,editors,and peer reviewers to use them for high-quality guidelines.