입원한 소아의 마이코플라스마 폐렴에서 치료 행태 분석: 다기관 후향적 연구
Real-world treatment pattern of mycoplasma pneumonia in hospitalized children: A multicenter retrospective study
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Purpose: Macrolide-refractory Mycoplasma pneumoniae pneumonia (MP) has markedly increased since 2003 and corticosteroids or second-line antibiotics, such as fluoroquinolones or tetracyclines, was considered an alternative treatment modality in macrolide-refractory MP. We aimed to show the real-world treatment pattern of MP in hospitalized children and compared clinical and laboratory findings between children with and without steroid treatment. Methods: We reviewed the medical records of 384 children diagnosed with MP from 6 hospitals in Korea from August 2015 to March 2016. We investigated the clinical, laboratory and radiologic findings, and medications used for the treatment of the subjects. Results: The corticosteroids and second-line antibiotics were administered in 55.5% and 7.0%, respectively. The percentages of steroid administration varied from 17% to 69% in each hospital. The mean start date of corticosteroid administration was 3.4 hospital days. Patients with corticosteroid treatment had a longer length of hospital stay than those without corticosteroid. They exhibited higher rates of lobar pneumonia and pleural effusion, and required longer days until improvement in chest X-ray findings. They also had higher rates of allergic diseases and showed higher C-reactive protein levels at admission. Conclusion: In the real-world practice studied in the 6 hospitals, corticosteroids were more frequently administered than second-line antibiotics to hospitalized children with MP. Children with corticosteroid adjuvant therapy had more severe pneumonia than those without. Randomized controlled trials are needed to make appropriate guidelines for macrolide-refractory MP.
Abstract
Purpose: Macrolide-refractory Mycoplasma pneumoniae pneumonia (MP) has markedly increased since 2003 and corticosteroids or second-line antibiotics, such as fluoroquinolones or tetracyclines, was considered an alternative treatment modality in macrolide-refractory MP. We aimed to show the real-world treatment pattern of MP in hospitalized children and compared clinical and laboratory findings between children with and without steroid treatment. Methods: We reviewed the medical records of 384 children diagnosed with MP from 6 hospitals in Korea from August 2015 to March 2016. We investigated the clinical, laboratory and radiologic findings, and medications used for the treatment of the subjects. Results: The corticosteroids and second-line antibiotics were administered in 55.5% and 7.0%, respectively. The percentages of steroid administration varied from 17% to 69% in each hospital. The mean start date of corticosteroid administration was 3.4 hospital days. Patients with corticosteroid treatment had a longer length of hospital stay than those without corticosteroid. They exhibited higher rates of lobar pneumonia and pleural effusion, and required longer days until improvement in chest X-ray findings. They also had higher rates of allergic diseases and showed higher C-reactive protein levels at admission. Conclusion: In the real-world practice studied in the 6 hospitals, corticosteroids were more frequently administered than second-line antibiotics to hospitalized children with MP. Children with corticosteroid adjuvant therapy had more severe pneumonia than those without. Randomized controlled trials are needed to make appropriate guidelines for macrolide-refractory MP.
참고문헌 (32)
- Eun BW, "Mycoplasma pneumoniae in Korean children : the epidemiology of pneumonia over an 18-year period", J Infect, 56, pp.326~331 (2008)
- 이은, "Prevalence and clinical manifestations of macrolide resistant Mycoplasma pneumoniae pneumonia in Korean children", Clinical and Experimental Pediatrics, 60(5), pp.151~157 (2017), 대한소아청소년과학회
- Hong KB, "Macrolide resistance of Mycoplasma pneumoniae, South Korea, 2000-2011", Emerg Infect Dis, 19, pp.1281~1284 (2013)
- 김종현, "Macrolide Resistance and Its Impacts on M. Pneumoniae Pneumonia in Children: Comparison of Two Recent Epidemics in Korea", Allergy, Asthma & Immunology Research, 9(4), pp.340~346 (2017), 대한천식알레르기학회
- Morozumi M, "Macrolide-resistant Mycoplasma pneumoniae : characteristics of isolates and clinical aspects of community-acquired pneumonia", J Infect Chemother, 16, pp.78~86 (2010)
- Cheong KN, "Severe macrolide-resistant Mycoplasma pneumoniae pneumonia associated with macrolide failure", J Microbiol Immunol Infect, 49, pp.127~130 (2016)
- Matsubara K, "A comparative clinical study of macrolide-sensitive and macrolide-resistant Mycoplasma pneumoniae infections in pediatric patients", J Infect Chemother, 15, pp.380~383 (2009)
- Luo Z, "Effects of prednisolone on refractory mycoplasma pneumoniae pneumonia in children", Pediatr Pulmonol, 49, pp.377~380 (2014)
- Waites KB, "Mycoplasma pneumoniae and its role as a human pathogen", Clin Microbiol Rev, 17, pp.697~728 (2004)
- 윤유숙, "Early Additional Immune-Modulators for Mycoplasma pneumoniae Pneumonia in Children: An Observation Study", Infection and Chemotherapy, 46(4), pp.239~247 (2014), 대한감염학회[DOI]
- Lee KY, "Role of prednisolone treatment in severe Mycoplasma pneumoniae pneumonia in children", Pediatr Pulmonol, 41, pp.263~268 (2006)
- Lu A, "Combined treatment for child refractory Mycoplasma pneumoniae pneumonia with ciprofloxacin and glucocorticoid", Pediatr Pulmonol, 46, pp.1093~1097 (2011)
- Miyashita N, "Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults", J Infect Chemother, 21, pp.153~160 (2015)
- Tagliabue C, "The impact of steroids given with macrolide therapy on experimental Mycoplasma pneumoniae respiratory infection", J Infect Dis, 198, pp.1180~1188 (2008)
- Tamura A, "Methylprednisolone pulse therapy for refractory Mycoplasma pneumoniae pneumonia in children", J Infect, 57, pp.223~228 (2008)
- Yamazaki T, "Epidemiology of Mycoplasma pneumoniae infections in Japan and therapeutic strategies for macrolide-resistant M", pneumoniae. Front Microbiol, 7, pp.693~ (2016)
- Ishiguro N, "Therapeutic efficacy of azithromycin, clarithromycin, minocycline, and tosufloxacin against macrolide-resistant and macrolide-sensitive Mycoplasma pneumoniae pneumonia in pediatric patients", PLoS One, 12, pp.e0173635~ (2017)
- Rhen T, "Antiinflammatory action of glucocorticoids—new mechanisms for old drugs", N Engl J Med, 353, pp.1711~1723 (2005)
- Montón C, "Role of glucocorticoids on inflammatory response in nonimmunosuppressed patients with pneumonia : a pilot study", Eur Respir J, 14, pp.218~220 (1999)
- Meijvis SC, "Dexamethasone and length of hospital stay in patients with community-acquired pneumonia : a randomised, double-blind, placebo-controlled trial", Lancet, 377, pp.2023~2030 (2011)
- Blum CA, "Adjunct prednisone therapy for patients with community-acquired pneumonia : a multicentre, double-blind, randomised, placebo-controlled trial", Lancet, 385, pp.1511~1518 (2015)
- Torres A, "Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response : a randomized clinical trial", JAMA, 313, pp.677~686 (2015)
- Oh J-W, "The critical initial markers for steroid therapy in refractory Mycoplasma pneumoniae pneumonia in children", J Allergy Clin Immunol, 139, pp.AB26~ (2017)
- Inamura N, "Management of refractory Mycoplasma pneumoniae pneumonia : utility of measuring serum lactate dehydrogenase level", J Infect Chemother, 20, pp.270~273 (2014)
- Lu A, "Lactate dehydrogenase as a biomarker for prediction of refractory Mycoplasma pneumoniae pneumonia in children", Respir Care, 60, pp.1469~1475 (2015)
- Kawamata R, "Utility of serum ferritin and lactate dehydrogenase as surrogate markers for steroid therapy for Mycoplasma pneumoniae pneumonia", J Infect Chemother, 21, pp.783~789 (2015)
- 김규원, "Hepatitis associated with Mycoplasma pneumoniae infection in Korean children: a prospective study", Clinical and Experimental Pediatrics, 58(6), pp.211~217 (2015), 대한소아청소년과학회
- Jujaray D, "Pattern and significance of asymptomatic elevation of liver enzymes in Mycoplasma pneumonia in children", Clin Pediatr(Phila), 57, pp.57~61 (2018)
- Izumikawa K, "Clinical features of severe or fatal Mycoplasma pneumoniae pneumonia", Front Microbiol, 7, pp.800~ (2016)
- Atkinson TP, "Deficient immune response to Mycoplasma pneumoniae in childhood asthma", Allergy Asthma Proc, 30, pp.158~165 (2009)
- Bao YX, "Atopy: a risk factor of refractory mycoplasma pneumoniae pneumonia?", Clin Respir J, 11, pp.931~934 (2017)
- Liu Y, "Characterization of macrolide resistance in Mycoplasma pneumoniae isolated from children in Shanghai, China", Diagn Microbiol Infect Dis, 67, pp.355~358 (2010)