Infection and Drug Resistance (Jul 2023)

Clinical Value of Metagenomics Next-Generation Sequencing in Antibiotic Resistance of a Patient with Severe Refractory Mycoplasma pneumoniae Pneumonia: A Case Report

  • Lin L,
  • Zhang R,
  • Zhang Z,
  • Chang Y,
  • Lin R,
  • Dou H,
  • Wang H,
  • Wang Y,
  • Zheng B

Journal volume & issue
Vol. Volume 16
pp. 4593 – 4597

Abstract

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Lianjun Lin,1,* Ruixue Zhang,1,* Zhi Zhang,2,3 Yujun Chang,2,3 Rongnan Lin,2,3 Haiwei Dou,4 He Wang,5 Yuchuan Wang,6 Bo Zheng7 1Geriatric Department, Peking University First Hospital, Beijing, People’s Republic of China; 2National Engineering Research Center for Beijing Biochip Technology, Beijing, People’s Republic of China; 3CapitalBio Corporation, Beijing, People’s Republic of China; 4Beijing Friendship Hospital, Capital Medical University, Beijing Tropical Medicine Research Institute, Beijing, People’s Republic of China; 5Department of Imaging, Peking University First Hospital, Beijing, People’s Republic of China; 6Department of Cardiology, Beijing Shijitan Hospital, Beijing, People’s Republic of China; 7Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhi Zhang, National Engineering Research Center for Beijing Biochip Technology, Changping District, Beijing, 102206, People’s Republic of China, Email [email protected] Lianjun Lin, Geriatric Department, Peking University First Hospital, Xishiku Avenue 8, Xicheng District, Beijing, 100034, People’s Republic of China, Email [email protected]: Mycoplasma pneumoniae is an important infectious pathogen of lower respiratory tract infection in children and adolescents. Macrolide resistant M. pneumoniae (MRMP) has become increasingly prevalent, and identifying pathogen resistance genes is crucial for treatment.Case Presentation: We report a patient with severe refractory M. pneumoniae pneumonia (MPP). The failure of initial clinical treatment prompted the re-analysis of metagenomic next-generation sequencing (mNGS) data for macrolide-resistant gene. Macrolide-resistance 23S ribosomal RNA gene was confirmed with read depth of 64 X for the A2063G mutation, which can decrease the affinity of macrolide with M. pneumoniae ribosome resulting in macrolide resistance. Furthermore, antimicrobial susceptibility testing demonstrated that M. pneumoniae was resistant to macrolide. PCR confirmatory test about M. pneumoniae resistance A2063G mutation, clinical treatment course and prognosis with altered treatment strategy, and M. pneumoniae antimicrobial susceptibility confirmed that the severe refractory MPP was due to macrolide resistant M. pneumoniae.Conclusion: As a new molecular level detection, mNGS is an effective method for detecting M. pneumoniae resistance genes. Early recognition of macrolide resistance and suitable antibiotics strategy is of vital importance for the prognosis of severe refractory MPP.Keywords: Mycoplasma pneumoniae, pneumonia, macrolide-resistant gene, metagenomic next-generation sequencing, A2063G mutation

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