2337. Clinical Characteristics of Children Infected With Macrolide-Resistant Mycoplasma Pneumonia in Central Ohio—Preliminary Data

Background Macrolide-resistant Mycoplasma pneumoniae (MRMp) has emerged in the last 2 decades, with rates as high as 93% in Asia. Rates in the United Stated vary from 3.5 to 13.2%. By sequencing we identified our local resistance rate of 1.8% (9/477) in isolates collected from October 2015 to December 2017. Previous reports described increased morbidity in patients with MRMp. We evaluated the clinical characteristics of children infected with MRMp in Central Ohio. Methods Of the 9 MRMp isolates identified, clinical data were available in 7 cases. We performed a case–control (1:3) analysis, where Mp patients were matched by month and year of presentation. Retrospective analysis of electronic health records (HER) was performed to identify clinical and treatment characteristics. Continuous variables are shown as medians and inter-quartile ranges (IQR), and categorical variables as percentages. For comparisons T, Mann–Whitney U, and Fisher’s exact tests were used as appropriate. Results Both groups had similar demographics with no differences in age and gender. Median age (IQR) was 8.5 years (6–17) for the MRMp and 8 (IQR 3.5–11.5) for the Macrolide-susceptible Mp (MSMp). Duration of symptoms at presentation was similar, median (IQR) of 11 (4–14) days for MRMp, and 8 (6.25–13.25) days for MSMp (P = 0.7). All patients with MRMp had fever compared with 17 (81%) of the MSMp (P = 0.07). Tmax was similar in both groups (P = 0.11). All patients (100%) had cough. There were no differences in the frequency of oxygen requirement, fatigue, shortness of breath, sore throat, nasal congestion, rash, headache and chest radiographic findings. There were similar rates of hospitalization with 4 (57%) in the MRMp and 8 (38%) in the MSMp (P = 0.42). Among hospitalized children, there were no differences in duration hospitalization, median (IQR) 6 (1.25–21.25) days for MRMp and 2 (1–2.75) for MSMp (P = 0.31). None required invasive ventilation. One MRMp patient had encephalitis; this was the only patient requiring intensive care compared with none MSMp (P = 0.25). All patients were initially treated with azithromycin, but 2 (12%) of the MRMp were switched to levofloxacin (P = 0.06). Conclusion We did not identify significant differences in clinical characteristics between patients with MRMp and MSMp. This could be related to our low local rate of MRMp. Disclosures O. Ramilo, Janssen Scientific Affairs, LLC: Consultant, Consulting fee. Sanofi: Scientific Advisor, Consulting fee. Merck: Scientific Advisor, Consulting fee and Speaker honorarium. Janssen: Grant Investigator and Scientific Advisor, Consulting fee, Grant recipient and Speaker honorarium. Pfizer: Consultant, Consulting fee and Speaker honorarium. A. Leber, Nationwide Children’s Hospital: Research Contractor, Research support.