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Recent Macrolide Resistance Pattern of Mycoplasma Pneumonia in the World: A Systematic Review and Meta-Analysis



Alavi Darazam I1, 2, 3 ; Rabiei MM1, 2 ; Javandoust Gharehbagh F1, 2 ; Hatami F1, 2 ; Shahrokhi S1 ; Akhgarzad A4 ; Allahverdi Nazhand H4 ; Ebadi H4 ; Zeininasab AH4 ; Kazeminia N5, 6 ; Lotfollahi L7 ; Shojaee S8
Authors
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Authors Affiliations
  1. 1. Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  3. 3. Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. Food and Drug Administration, Iran Ministry of Health and Medical Education, Tehran, Iran
  6. 6. Clinical Study and Pharmacovigilance Department, Food and Drug Administration, Tehran, Iran
  7. 7. Department of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  8. 8. Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: Iranian Journal of Public Health Published:2025

Abstract

Background: We aimed to systematically review and analyze the prevalence and pattern of resistance in Myco-plasma pneumoniae. Methods: We searched authentic scientific sources and databases, and reference lists of relevant articles from Jan 1, 2017, to Jun 1, 2023. Results: Most of the included studies were conducted in Asia (11470 patients). The overall pooled prevalence was 53% (41%-65%), I2=99.69%; P <0.001. While subgroups analyses revealed that the pooled prevalence for America (3 studies), Asia (29 studies), and Europe (3 studies) was 9% (5%-12%), 62% (52%-73%), and 6% (1%-12%), respectively. Twenty-one eligible studies for determining of A2063G and 16 for A2064G were ana-lyzed. Global pooled prevalence was 67% (58%-76%), I2=99.65%; P<0.001, and 3% (2%-4%), I2=87.44%; P<0.001 for A2063G and A2064G, respectively. Pooled prevalence of A2063G for America, Asia and Europe was 10% (5%-16%), 77% (71%-83%) and 5% (2%-9%), respectively. Conclusion: While the prevalence of macrolide-resistant M. pneumonia is quite low in America, it is a great di-lemma in East Asia and the low prevalence in most countries could be underestimated. This study revealed an increasing trend in macrolide resistance. Indiscriminate and improper use of macrolides may be a warning in this regard. © 2025 Alavi Darazam et al.
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