LITERATURE UPDATE


infection in past years. Clinically significant acquired macrolide-resistant M. pneumoniae (MRMP) has emerged worldwide which may be associated with more extrapulmonary complications, and severe clinical and radiological features. Since molecular-based assays


can detect M. pneumoniae in clinical specimens, there is a need for real point-of-care testing for fast detection of M. pneumoniae or its DNA and mutations in the macrolide resistance gene. It is necessary to develop safe vaccines that provide protective immunity against M. pneumoniae infection.


Macrolide resistance in Mycoplasma pneumoniae in adult patients Xie P, Zhang Y, Qin Y et al. Front Cell Infect Microbiol. 2025 Mar 4;15:1496521. doi: 10.3389/fcimb.2025.1496521. eCollection 2025.


Mycoplasma pneumoniae is one of the most significant pathogens responsible for respiratory infections in humans. Macrolides are recommended as the first- line treatment for M. pneumoniae infection. The prevalence of macrolide-resistant M. pneumoniae has increased significantly in recent decades, particularly in China. The mechanisms of resistance in M. pneumoniae to macrolides have been extensively studied in paediatric patients. However, there is a paucity of reports regarding the resistance characteristics and mechanisms exhibited in adults. The aim of this study was to elucidate


the resistance of M. pneumoniae to macrolides and the underlying mechanisms in adult patients. Pharyngeal swab specimens were collected from adult patients presenting with subacute cough or community-acquired pneumonia at the authors’ hospital from January 2011 to June 2017 to identify and isolate M. pneumoniae strains. The antimicrobial susceptibility of these isolates to three macrolide antibiotics was assessed using a broth microdilution method. The 23S rRNA genes of macrolide-


resistant M. pneumoniae strains were sequenced, and the presence of target methylation genes (ermA, ermB, and ermC), efflux pump genes (mefA, mefA/E, msrA, and msrA/B), and the macrolide resistance gene mphC was identified through polymerase chain reaction (PCR) testing. Additionally, MICs were determined with and without the efflux pump inhibitor reserpine. A total of 72 M. pneumoniae strains


were isolated from adult patients, with 41.7% (30/72) exhibiting macrolide resistance. Among the three macrolides tested, the 16-membered-ring midecamycin


exhibited the greatest activity (MIC90 : 16


µg/mL) against M. pneumoniae. All macrolide-resistant M. pneumoniae strains harboured mutations at the 2063 site in domain V of the 23S rRNA gene. Two macrolide-resistant M. pneumoniae clinical isolates were found to harbour the efflux pump genes msrA/B and mefA. The efflux pump inhibitor reserpine reduced the MIC for azithromycin in these two strains to a quarter of their original values. In summary, macrolide-resistant


M. pneumoniae is commonly observed among adults in Beijing. Point mutations are the primary mechanism responsible for macrolide resistance in adults with M. pneumoniae. Additionally, the efflux pump mechanism may contribute partially to this resistance. Midecamycin presents a promising alternative drug for treating M. pneumoniae infections, particularly in cases of azithromycin-resistant M. pneumoniae infection in young children.


A novel thermo-activated one-pot RPA- CRISPR-Cas12b assay for Mycoplasma pneumoniae POCT Feng J, Wu Z, Zhu W et al. Biosens Bioelectron. 2025 Nov 15;288:117839. doi: 10.1016/j.bios.2025.117839.


Mycoplasma pneumoniae, a major human respiratory pathogen, necessitates the development of rapid point-of-care testing (POCT) platforms for clinical management. However, current two- step workflows suffer from operational complexity and aerosol contamination risks. This limitation stems from CRISPR- Cas12-mediated template degradation in single-reaction systems, which compromises amplification efficiency and detection sensitivity. Here, the authors combined RPA and CRISPR Cas12b by leveraging the difference in their optimal temperatures to construct a novel TRACER (Thermo- activated RPA Amplification for CRISPR- Cas12b Efficient Recognition) technology. Through precise temperature modulation, TRACER sequentially executes isothermal amplification and CRISPR-mediated detection while preventing premature template cleavage, thereby maintaining optimal reaction efficiency. The platform demonstrates exceptional


analytical sensitivity with a detection limit of 1 copy/μL, representing a 100-fold improvement over conventional one-pot RPA-CRISPR-Cas12a systems. Clinical validation using 195 specimens revealed diagnostic performance metrics of 99.2% sensitivity (119/120), 100.0% specificity (75/75), and 99.5% accuracy (194/195). This innovative combination of


single-tube reaction, field-deployable 52 WWW.PATHOLOGYINPRACTICE.COM August 2026


instrumentation, and cost-effectiveness establishes TRACER as an ideal POCT solution for M. pneumoniae detection in diverse clinical setings.


Mycoplasma pneumoniae respiratory tract infections in children: when and how to diagnose and treat Sharplin L, Goyal V. Breathe (Sheff). 2025 Oct 14;21(4):250046. doi: 10.1183/20734735.0046-2025. eCollection 2025 Oct.


Mycoplasma pneumoniae is a frequent cause of respiratory tract infections both in children and adults, responsible for up to 30% of community-acquired pneumonia cases in children. While many infected individuals remain asymptomatic, common symptoms include fever – which is typically short-lived – and a persistent cough, sometimes lasting weeks. Early identification of M. pneumoniae is crucial for effective management. However, distinguishing it from other viral or bacterial lower respiratory tract infections based on symptoms alone is unreliable due to the non-specific clinical presentation. Currently, the most accurate method


for diagnosing M. pneumoniae is PCR testing, as traditional culture methods are slow and technically challenging. Paired serology testing is also used for diagnosis. It is important to evaluate locally available diagnostic resources. First-line treatment typically involves


macrolide antibiotics, despite lack of robust data for their use. However, widespread use has contributed to increasing macrolide resistance, especially in Asia, prompting consideration of alternatives like fluoroquinolones and tetracyclines. In severe or treatment- resistant cases, additional therapies such as prednisolone, intravenous immunoglobulin or bronchoscopy may be used, although evidence supporting their routine application is limited. Overall, clinical decisions should be individualised, guided by local transmission paterns, available diagnostics and emerging antibiotic resistance paterns.


PCR sensitivity for Mycoplasma pneumoniae detection in nasopharyngeal and oropharyngeal swabs: a comparative study Kitagawa D, Nishihara S, Murata M et al. J Clin Microbiol. 2025 Aug 13;63(8):e0045825. doi: 10.1128/jcm.00458-25.


The differential impact of sample type on polymerase chain reaction (PCR) detection of Mycoplasma pneumoniae (MP) has rarely been investigated. The


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