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

Lianjun Lin; Ruixue Zhang; Zhi Zhang; Yujun Chang; Rongnan Lin; Haiwei Dou; He Wang; Yuchuan Wang; Bo Zheng

doi:10.2147/IDR.S419873

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

Infect Drug Resist. 2023 Jul 13:16:4593-4597. doi: 10.2147/IDR.S419873. eCollection 2023.

Authors

Lianjun Lin^#¹, Ruixue Zhang^#¹, Zhi Zhang^{2

3}, Yujun Chang^{2

3}, Rongnan Lin^{2

3}, Haiwei Dou⁴, He Wang⁵, Yuchuan Wang⁶, Bo Zheng⁷

Affiliations

¹ Geriatric Department, Peking University First Hospital, Beijing, People's Republic of China.
² National Engineering Research Center for Beijing Biochip Technology, Beijing, People's Republic of China.
³ CapitalBio Corporation, Beijing, People's Republic of China.
⁴ Beijing Friendship Hospital, Capital Medical University, Beijing Tropical Medicine Research Institute, Beijing, People's Republic of China.
⁵ Department of Imaging, Peking University First Hospital, Beijing, People's Republic of China.
⁶ Department of Cardiology, Beijing Shijitan Hospital, Beijing, People's Republic of China.
⁷ Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, People's Republic of China.

^# Contributed equally.

Abstract

Background: 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: A2063G mutation; Mycoplasma pneumoniae; macrolide-resistant gene; metagenomic next-generation sequencing; pneumonia.

Publication types

Case Reports

Grants and funding

This work was supported by National Key R&D Program of China (Grant number: 2020YFC2005401, 2020YFC2005406), Xicheng financial, scientific and technological project (Grant number: XCSTS-SD2021-02), Project funded by Baidu Fund of Peking University (Grant number: 2020BD045), Capital Health Development Scientific Research Project (Grant number: 2021-1G-4301), and National Natural Science Foundation of China (Grant number: 8211101008).