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Volume 32, Number 11—November 2026

Research

Emergence of Novel Macrolide-Resistant Mycoplasma pneumoniae Sequence Type 3 Subclades in Children after COVID-19 Pandemic, Taiwan

Yu-Chia Hsieh, Chen-Ching Lin, Jia-Wen Wu, Yi-Hsuan Liu, Yi-Jiun Pan, Tzu-Ya Lo, Shian-Sen Shie, Huey-Ling You, Chong-Wei Huang, Yi-Chuan Huang, Tzu-Ching Huang, Yu-Xin She, Yin-Cheng Chen1, and Shiao-Wen Li1Comments to Author 
Author affiliation: Chang Gung Children’s Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan (Y.-C. Hsieh, J.-W. Wu, Y.-H. Liu, T.-Y. Lo); School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-C. Lin, Y.-C. Chen); School of Medicine, College of Medicine, People’s Republic of China Medical University, Taichung, Taiwan (Y.-J. Pan); Chang Gung Memorial Hospital, Taoyuan (S.-S. Shie); Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (H.-L. You); Keelung Chang Gung Memorial Hospital, Keelung, Taiwan (C.-W. Huang, Y.-C. Huang); School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei (T.-C. Huang); College of Science Department of Life Sciences, National University of Kaohsiung, Kaohsiung (Y.-X. She, S.-W. Li)

Main Article

Table 2

Demographic, clinical, laboratory and radiologic characteristics and risk factors for ICU admission in study of emergence of novel macrolide-resistant Mycoplasma pneumoniae sequence type 3 subclades in children after COVID-19 pandemic, Taiwan, 2023–2024 (n = 226)*

Characteristic ICU admission, N = 17 Non-ICU admission, N = 209 p value Univariate analysis
 Multivariate analysis
OR (95% CI) p value OR (95% CI) p value
Age, y, median (IQR)
 8.5 (7.8–12.0)
 8.9 (7.2–10.6)
 0.5
 1.06 (0.9–1.23)
 0.44
–
 –
Male sex
 9 (52.9)
 106 (50.7)
 1.0
 0.92 (0.34–2.46)
 0.86
–
 –
Days from symptom onset to hospital admission, median (IQR)
 5.0 (1.5–7.0)
 6.0 (4.0–7.0)
 0.3
 0.89 (0.7–0.11)
 0.32
–
 –
Receiving effective treatment
 16 (94.1)
 195 (93.3)
 1.0
 1.15 (0.14–9.3)
 0.9
–
 –
Days from symptom onset to effective treatment, median (IQR)
 7.0 (5.0–7.0)
 7.0 (5.0–8.3)
 0..3
 0.86 (0.7–1.08)
 0.2
–
 –
Total days with fever, median (IQR)
 9 (4–12)
 8.0 (6.0–9.0)
 0.5
 1.06 (0.9–1.3)
 0.5
–
 –
Hospital duration, d, median (IQR)
 13.0 (11.5–15.5)
 5.0 (1.0–8.0)
 <0.001
 1.71 (1.4–2.1)
 <0.001
–
 –
Laboratory characteristic
Leukocytes, × 103 cells/μL, median (IQR) 11.7 (9.75–13.35) 7.2 (6.0–8.8) <0.001 1.0 (1.0–1.0) <0.001 ND ND
Neutrophil count >7000 cells/μL 13 (76.5) 31 (14.8) <0.001 18.7 (5.7–61) <0.001 6.2 (1.3–29.9) 0.02
Hemoglobin, g/dL, median (IQR) 11.7 (9.7–13.4) 12.3 (11.7–13.1) 0.15 0.77 (0.5–1.06) 0.11 - -
Platelets, × 103/μL, median (IQR) 451 (265–648) 264 (212–320) <0.001 1.0 (1.0–1.0) <0.001 ND ND
Platelet count >400 × 103/μL 11 (64.7) 19 (9.1) <0.001 18.3 (6.1–55.1) <0.001 12.5 (2.68–57.9) 0.001
CRP, mg/L, median (IQR) 45.7 (11–154.4) 26.6 (14.3–62.8) 0.23 1.01 (1.001–1.01) 0.01 1.002 (0.99–1.01) 0.6
AST, U/L, median (IQR) 26.0 (18.5–140.0) 28.0 (23.0–47.3) 0.49 1.001 (1.0–1.003) 0.6
ALT, U/L, median (IQR) 24.0 (12.0–153.3) 13.0 (9.0–22.0) 0.02 1.001 (1.0–1.003) 0.3
Codetection 3 (17.6) 59 (28.2) 0.4 0.54 (0.15–1.97) 0.4
Macrolide resistance
 17 (100)
 202 (96.7)
 1.0
 ND
 ND
ST 0.5 ND ND
ST3 15 (88.2) 192 (91.9)
ST14 2 (11.8) 12 (5.7)
Others
 0
 5 (2.4)
Chest radiography findings
Increased infiltration 8 (47.1) 71 (34) 0.3 1.7 (0.6–4.7) 0.28
Patchy consolidation 9 (52.9) 138 (66) 0.3 0.58 (0.2–1.57) 0.28
Pleural effusion
 5 (29.4)
 14 (6.7)
 0.008
 5.8 (1.8–18.8)
 0.003
9.96 (1.6–58.1)
 0.01
CNS complication 21.4 (5.07–89.9) <0.001 27.9 (4.1–188.3) 0.001

*Values are no. (%) except as indicated. AST, aspartate aminotransferase; ALT, alanine aminotransferase; CNS, central nervous system; CRP, Cc-reactive protein; ICU, intensive care unit; ND, not done; OR, odds ratio; ST, sequence type.

Main Article

1These senior authors contributed equally to this article.

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