Prevalence of macrolide resistance in Mycoplasma pneumoniae in The Netherlands

Background: Macrolide resistance in Mycoplasma pneumoniae is an increasing concern worldwide. Objectives: To investigate the prevalence of macrolide resistance in M. pneumoniae in The Netherlands. Methods: All non-duplicate consecutive specimens with a positive M. pneumoniae PCR were prospectively collected by four hospital laboratories during the outbreak of M. pneumoniae infection in 2023/2024 in The Netherlands. The two most common mutations in the 23S rRNA gene that are known to cause macrolide resistance, A2063G and A2064G, were detected by PCR with melting curve analysis. Results: PCR-positive specimens were identified in 268 patients. Of the 268 PCR-positive specimens, 238 were available for analysis of which 235 could be amplified for mutational analysis. Mutations were detected in 7 of 235 specimens (3%). Conclusions: The low resistance rate of 3% still supports the use of macrolides for empirical treatment of M. pneumoniae infections in The Netherlands, but macrolide non-responsive infections should lead to the suspicion of resistant M. pneumoniae. Regular surveillance studies are important as clonal spread may cause rapid changes in resistance rates.