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Macrolide‐resistant Mycoplasma pneumoniae pneumonia in transplantation: Increasingly typical?
Author(s) -
Eschenauer Gregory A.,
Xiao Li,
Waites Ken B.,
Crabb Donna M.,
Ratliff Amy E.,
Gandhi Tejal N.,
Riddell James,
Kaul Daniel R
Publication year - 2020
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13318
Subject(s) - mycoplasma pneumoniae , medicine , pneumonia , levofloxacin , azithromycin , community acquired pneumonia , doxycycline , drug resistance , chlamydophila pneumoniae , microbiology and biotechnology , immunology , chlamydia , antibiotics , chlamydiaceae , biology
Mycoplasma pneumoniae is one of the most common bacterial causes of pneumonia. Macrolide‐resistant M pneumoniae (MRMP) was documented in 7.5% of isolates in the United States. Resistance portends poor outcomes to macrolide therapy, yet patients respond well to fluoroquinolones or tetracyclines such as minocycline. However, MRMP may be under‐appreciated because M pneumoniae generally causes relatively mild infections in non‐immunosuppressed adults that may resolve without effective therapy and because microbiological confirmation and susceptibility are not routinely performed. We report two cases of pneumonia due to MRMP in kidney transplant recipients. Both patients required hospital admission, worsened on macrolide therapy, and rapidly defervesced on doxycycline or levofloxacin. In one case, M pneumoniae was only identified by multiplex respiratory pathogen panel analysis of BAL fluid. Macrolide resistance was confirmed in both cases by real‐time PCR and point mutations associated with macrolide resistance were identified. M pneumoniae was isolated from both cases, and molecular genotyping revealed the same genotype. In conclusion, clinicians should be aware of the potential for macrolide resistance in M pneumoniae , and may consider non‐macrolide‐based therapy for confirmed or non‐responding infections in patients who are immunocompromised or hospitalized.