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<p>Following the COVID-19 pandemic, infections with <i>Mycoplasma pneumoniae (M. pneumoniae)</i> have resurged globally. However, post-pandemic changes in clinical phenotypes, severity, and extrapulmonary manifestations remain poorly characterised in pediatric populations. This study aimed to characterise the clinical spectrum, severity patterns, and phenotypic differences of <i>M. pneumoniae</i> infection in hospitalised children following the COVID-19 pandemic, and to identify risk factors for critical illness in a multicenter cohort. This multicenter retrospective study included 400 hospitalised children with confirmed <i>M. pneumoniae</i> infection across 20 tertiary pediatric centres in Turkey between July 2021 and July 2024. Demographic, clinical, laboratory, and radiologic features were analysed. Groups were compared by age, pulmonary versus extrapulmonary phenotypes, and disease severity. Multivariate logistic regression was used to identify predictors of critical illness. A total of 400 hospitalised children with confirmed <i>M. pneumoniae</i> infection were included in the study, of whom 212 (53%) were male. The median age was 88&#xa0;months (interquartile range [IQR]: 48–124&#xa0;months). Underlying conditions were present in 110/400 (27.5%) patients, with asthma/reactive airway disease, neurological disorders, and hematologic/oncologic disorders being the most common comorbidities. Pneumonia was identified in 303/400 (75.8%) patients. Extrapulmonary organ involvement was observed in 79/400 (19.8%) patients, predominantly affecting the hematologic and neurologic systems. Critical illness criteria were met in 216/400 (54%) patients. Oxygen support was required in 145/400 (36.3%), and ICU admission occurred in 36/400 (9%). Children ≥ 5&#xa0;years were more likely to present with lobar pneumonia, while those &lt; 5&#xa0;years had higher rates of gastrointestinal symptoms without severe inflammation. Fever, cough, and CRP elevation were strongly associated with pulmonary disease (<i>p</i> &lt; 0.001). Elevated neutrophil count independently predicted critical illness (OR: 1.002; 95% CI: 1.000–1.004; <i>p</i> = 0.046). Treatment varied by phenotype: clarithromycin was used more frequently in pneumonia cases, while azithromycin, corticosteroids, and IVIG were more commonly used in extrapulmonary cases.</p><p><i>Conclusion</i>: In the post-COVID-19 era, pediatric <i>M. pneumoniae</i> infections show increased severity and clinical diversity. Distinct phenotypes and age-related patterns underscore the need for tailored care. Prospective studies with resistance and immune profiling are needed to inform future management strategies.<Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> <p><b>What is Known:</b></p> <p>• <i>The post-COVID era has seen a resurgence and a changing clinical spectrum of Mycoplasma pneumoniae infections in children.</i></p> </entry> </row> <row> <entry align="left" colname="c1"> <p><b>What is New:</b></p> <p>• <i>This study presents the first large-scale, multicenter post-pandemic cohort from Turkey.</i></p> <p>• <i>In addition to pulmonary and extrapulmonary cases, a distinct critical illness group was identified, in which absolute neutrophil count emerged as an independent but modest risk marker for severity.</i></p> </entry> </row> </tbody> </tgroup> </Table></p>

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Mycoplasma pneumoniae in hospitalised children in the post-COVID era: clinical outcomes from a Turkish multicenter cohort

  • 期刊论文

  • 发表日期：

    2025年11月20日

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  • Coskun Ekemen,
  • Gulhadiye Avcu,
  • Esra Cakmak Taskin,
  • Mehlika Efendi Kocagoz,
  • Nurdan Kayki Aksoy,
  • Elif Somuncu,
  • Hacer Yakin,
  • Mavera Usaklioglu Erol,
  • Meryem Cagla Abaci Capar,
  • Guldane Dikme,
  • Senem Behsat Ulukaya,
  • Onur Tekeli,
  • Hincal Ozbakir,
  • Ayse Gul Yucel,
  • Hatice Sinav Utku,
  • Esma Tugba Kasikci Mermer,
  • Emel Celebi Congur,
  • Ulkiye Gungor,
  • Merve Nur Kilic,
  • Mehmet Emin Menentoglu,
  • Asli Arslan,
  • Gulben Ozgul Postuk,
  • Nahide Gokay,
  • Eda Sahin Izci,
  • Hatice Burcu Caglar Kizil,
  • Ergin Ciftci,
  • Halil Ozdemir,
  • Gul Arga,
  • Zumrut Sahbudak Bal,
  • Emine Hafize Erdeniz,
  • Canberk Cinar,
  • Hacer Akturk,
  • Semra Bayturan Sen,
  • Nursen Belet,
  • Selim Öncel,
  • Melike Emiroglu,
  • Aybuke Akaslan Kara,
  • Tugce Tural Kara,
  • Nazan Dalgic,
  • Edanur Yesil,
  • Sevliya Ocal Demir,
  • Gulsen Akkoc,
  • Ayse Buyukcam,
  • Selda Hancerli Torun,
  • Yasemin Ozsurekci,
  • Kubra Aykac,
  • Zeynep Gokce Gayretli Aydin,
  • Ozden Turel,
  • Nevin Hatipoglu

摘要

Following the COVID-19 pandemic, infections with Mycoplasma pneumoniae (M. pneumoniae) have resurged globally. However, post-pandemic changes in clinical phenotypes, severity, and extrapulmonary manifestations remain poorly characterised in pediatric populations. This study aimed to characterise the clinical spectrum, severity patterns, and phenotypic differences of M. pneumoniae infection in hospitalised children following the COVID-19 pandemic, and to identify risk factors for critical illness in a multicenter cohort. This multicenter retrospective study included 400 hospitalised children with confirmed M. pneumoniae infection across 20 tertiary pediatric centres in Turkey between July 2021 and July 2024. Demographic, clinical, laboratory, and radiologic features were analysed. Groups were compared by age, pulmonary versus extrapulmonary phenotypes, and disease severity. Multivariate logistic regression was used to identify predictors of critical illness. A total of 400 hospitalised children with confirmed M. pneumoniae infection were included in the study, of whom 212 (53%) were male. The median age was 88 months (interquartile range [IQR]: 48–124 months). Underlying conditions were present in 110/400 (27.5%) patients, with asthma/reactive airway disease, neurological disorders, and hematologic/oncologic disorders being the most common comorbidities. Pneumonia was identified in 303/400 (75.8%) patients. Extrapulmonary organ involvement was observed in 79/400 (19.8%) patients, predominantly affecting the hematologic and neurologic systems. Critical illness criteria were met in 216/400 (54%) patients. Oxygen support was required in 145/400 (36.3%), and ICU admission occurred in 36/400 (9%). Children ≥ 5 years were more likely to present with lobar pneumonia, while those < 5 years had higher rates of gastrointestinal symptoms without severe inflammation. Fever, cough, and CRP elevation were strongly associated with pulmonary disease (p < 0.001). Elevated neutrophil count independently predicted critical illness (OR: 1.002; 95% CI: 1.000–1.004; p = 0.046). Treatment varied by phenotype: clarithromycin was used more frequently in pneumonia cases, while azithromycin, corticosteroids, and IVIG were more commonly used in extrapulmonary cases.

Conclusion: In the post-COVID-19 era, pediatric M. pneumoniae infections show increased severity and clinical diversity. Distinct phenotypes and age-related patterns underscore the need for tailored care. Prospective studies with resistance and immune profiling are needed to inform future management strategies.

What is Known:

• The post-COVID era has seen a resurgence and a changing clinical spectrum of Mycoplasma pneumoniae infections in children.

What is New:

• This study presents the first large-scale, multicenter post-pandemic cohort from Turkey.

• In addition to pulmonary and extrapulmonary cases, a distinct critical illness group was identified, in which absolute neutrophil count emerged as an independent but modest risk marker for severity.