关于 Mycoplasma pneumoniae

The Mycoplasma pneumoniae (MP) genome is a double-stranded circular DNA with a size of approximately 820 kb and over 600 protein-coding genes, indicating a small and simple structure. Due to its highly streamlined genome, MP cannot synthesize essential molecules such as amino acids and nucleotides from scratch. Instead, it relies on close binding to host cells to take up essential substances such as cholesterol, and the in vitro culture conditions for MP are also demanding^[1]. Since the release of genome information of the first MP strain in 1996, our understanding of the organism’s biological properties has significantly enhanced at the genetic level. Based on the repetitive sequences of the P1 protein-coding genes Rep2/3 and Rep4, which are part of the apical adhesion structure, MP can be simply classified into P1-type I and P1-type II, with a high degree of genomic conservation within each type^[2]. Epidemiological surveillance of MP showed that P1-type I was the predominant strain with a high percentage of drug resistance, whereas, since 2015, there has been a gradual increase in P1-type II in multiple countries^{[3, 4]}

MP is one of the smallest self-replicating organisms without a cell wall, which makes them intrinsically resistant to β-lactams and to all cell-wall targeting antimicrobials^[5]. Among children, MP accounts for 10–40% of Community-acquired pneumonia cases, consistently ranking as a leading cause of morbidity and mortality^[6]. According to the Global Burden of Disease 2021 Lower Respiratory Infections and Antimicrobial Resistance Collaborators study, Mycoplasma spp was responsible for 25.3 million lower respiratory tract infections (LRTIs) in 2021, making it the third most common pathogen contributing to LRTIs globally^[7]. The COVID-19 pandemic saw a reduction in MP infections due to widespread non-pharmaceutical interventions. However, with the relaxation of these measures, a resurgence of MP cases has been observed in countries including China, Denmark, France, the Netherlands, and Spain^[8].

Macrolide antibiotics are commonly used as the first-line treatment for M. pneumoniae infections in children. In recent years, the rising proportion of macrolide-resistant MP (MRMP) in China has posed significant challenges to clinical treatment^[9]. The primary resistance mechanism is the target mutation at site 2063 A→G in the 23S rRNA V region, which leads to high drug resistance, and no other macrolide-resistant mechanisms have been reported^[2]. Reports from various regions, including Beijing, Zhejiang, Wuhan, Shanghai, Inner Mongolia, and Northeast China, have highlighted the prevalence of MP in 2023^[10].

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Lineage Distribution

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P1 Gene Typing Distribution

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菌株MLST