Macrolide-resistant Mycoplasma pneumoniae resurgence in Chinese children in 2023: a longitudinal, cross-sectional, genomic epidemiology study

作者：Chao Yan, Shanwei Tong, Yarong Wu, Yujie Chen, Xinyu Jia, Yan Guo, Mengnan Cui, Guangqian Pei, Zuming Zhang, Hao Zhou, Ketao Mu, Xue Ren, Bing Du, Hanqing Zhao, Yanling Feng, Jinghua Cui, Yuyan Xia, Zhen Wang, Yu Sun, Linqing Zhao, Chuangli Hao, Zhijie Zhu, Shengqiang Luo, Han Zhang, Yongjun Wang, Lili Zhong, Dehui Chen, Zhiying Han, Yong Yin, Hu Li, Yuehua Ke, Guanhua Xue, Ling Cao, Xavier Didelot, Jing Yuan, Yujun Cui · 发表于：The Lancet Microbe · 年份：2025 · DOI：10.1016/j.lanmic.2025.101200 · 被引用次数：11 · 研究领域：Pneumonia and Respiratory Infections、Microbial infections and disease research、Bacterial Infections and Vaccines

BACKGROUND: After a prolonged period of low detection rates, Mycoplasma pneumoniae resurged in China, during September to November, 2023, raising global concern. This study aims to gain a better understanding of the genetic mechanisms underlying the 2023 increase in cases and the evolutionary dynamics of the epidemic populations, which has been previously hampered due to limited genomic data of this pathogen. METHODS: We sequenced 685 M pneumoniae isolates, including 248 isolates from 11 Chinese provinces and municipalities in 2023 and 437 isolates from Beijing (2013-22). By analysing these isolates and 436 publicly global sequences, we reconstructed the pathogen's evolutionary history using time-calibrated phylogenies and effective population size inference. We investigated potential genomic variations contributing to the 2023 resurgence through genome-wide association study and conducted phylogeographic analysis of the 2023 isolates across China. FINDINGS: Two macrolide-resistant epidemic clusters (T1-2-EC1 and T2-2-EC2) were responsible for the 2023 resurgence in China. Both clusters, having acquired the 23S ribosomal RNA A2063G mutation conferring macrolide resistance, emerged in approximately 1997 and 2014, respectively, and subsequently outcompeted their predecessor populations. This coincided with China's large-scale adoption of azithromycin for paediatric community-acquired pneumonia around the early 2000s. Aside from macrolide resistance, T1-2-EC1 independently acqui...