Application of Metagenomic Next-Generation Sequencing Combined with Omadacycline in Refractory Mycoplasma Pneumoniae Pneumonia: Four Cases Report and Literature Review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

QIN Yuhong ¹ , HUANG Jian’an ² ,  ZHANG Xiaohui ²

1. Center of Clinical Laboratory and Translational Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 2151213, P.R. China;
2. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, P.R. China;

Corresponding author：

ZHANG Xiaohui, Email: zhangxiaohui@suda.edu.cn

Keywords：

Metagenomic next-generation sequencing(mNGS); omadacycline; refractory mycoplasma pneumoniae pneumonia(RMPP)

DOI：

10.7507/1671-6205.202502078

Video：

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Objective To explore the application and clinical value of metagenomic next-generation sequencing (mNGS) combined with Omadacycline in the treatment of Refractory Mycoplasma pneumoniae pneumonia (RMPP).Methods The clinical data, relevant laboratory results, diagnosis and treatment process, and imaging outcomes of four patients diagnosed with Mycoplasma pneumoniae pneumonia through mNGS were analyzed. Results The clinical symptoms at onset in all four patients were consistent with Mycoplasma pneumoniae pneumonia. After conventional treatment with macrolides, tetracyclines, or quinolone antibiotics, the symptoms showed no significant improvement, and there was a trend of radiological worsening. Following the confirmation of Mycoplasma pneumoniae infection through mNGS of bronchoalveolar lavage fluid, and due to various reasons preventing the use of the aforementioned drugs, omadacycline was ultimately chosen for treatment. Radiological improvements were observed in all cases, leading to a good prognosis and discharge. Conclusions For pneumonia cases where the infectious pathogen cannot be identified and conventional treatment has failed, mNGS can be utilized for early and accurate diagnosis. In cases of RMPP, Omadacycline can be employed as an alternative treatment to prevent delays in care and reduce the risk of complications.

Citation： QIN Yuhong, HUANG Jian’an, ZHANG Xiaohui. Application of Metagenomic Next-Generation Sequencing Combined with Omadacycline in Refractory Mycoplasma Pneumoniae Pneumonia: Four Cases Report and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(6): 389-394. doi: 10.7507/1671-6205.202502078 Copy

1.	Huang X, Li D, Liu F, et al. Clinical significance of D-dimer levels in refractory Mycoplasma pneumoniae pneumonia. BMC Infect Dis. 2021, 21(1): 14.
2.	Tong L, Huang S, Zheng C, et al. Refractory Mycoplasma pneumoniae pneumonia in children: early recognition and management. J Clin Med. 2022, 11(10): 2824.
3.	Meng HY, Dah CY, Chao JW, et al. The clinical significance of and the factors associated with macrolide resistance and poor macrolide response in pediatric Mycoplasma pneumoniae infection: A retrospective study. J Microbiol Immunol Infect, 2023, 56(3): 634-640.
4.	Roman S, Monica P, Joven RG, et al. Omadacycline for Community-Acquired Bacterial Pneumonia. N Engl J Med, 2019, 380(6): 517-527.
5.	Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U. S. children. N Engl J Med, 2015, 372(9): 835-845.
6.	Luo XQ, Luo J, Wang CJ, et al. Clinical features of severe Mycoplasma pneumoniae pneumonia with pulmonary complications in childhood: A retrospective study. Pediatr Pulmonol, 2023, 58(10): 2815-2822.
7.	尹辛大, 郑倩文. 妊娠期重症支原体肺炎并噬血细胞综合征一例并文献复习. 中国呼吸与危重监护杂志, 2022, 21(10): 741-744.
8.	Huang X, Gu HY, Wu RX, et al. Chest imaging classification in Mycoplasma pneumoniae pneumonia is associated with its clinical features and outcomes. Respiratory Medicine, 2024, 221: 107480.
9.	Tang M, Wang D, Tong X, Wu, et al. Comparison of different detection methods for Mycoplasma pneumoniae infection in children with community-acquired pneumonia. BMC Pediatr, 2021, 21(1): 90-107.
10.	Qu JM, Zhang J, Chen Y, et al. Aetiology of severe community acquired pneumonia in adults identified by combined detection methods: a multi-centre prospective study in China. Emerg Microbes Infect, 2022, 11(1): 556-566.
11.	Liu ZG, Sun C, Xiao XR, et al. Application of metagenomic next-generation sequencing (mNGS) in diagnosing pneumonia of adults. J Infect Dev Ctries, 2023, 17(11): 1566-1573.
12.	Wang N, Zhang H, Yin Y, et al. Antimicrobial susceptibility profiles and genetic characteristics of Mycoplasma pneumoniae in Shanghai, China, from 2017 to 2019. Infect Drug Resist, 2022, 15: 4443-4452.
13.	He YS, Yang M, Liu G, et al. Safety study of moxifloxacin in children with severe refractory Mycoplasma pneumoniae pneumonia. Pediatr Pulmonol, 2023, 58(7): 2017-2024.
14.	赵顺英, 钱素云, 陈志敏, 等. 儿童肺炎支原体肺炎诊疗指南(2023年版). 新发传染病电子杂志, 2024, 9(01): 73-79.
15.	George S, Nowak M, Geriak M, et al. Omadacycline in treating community-based infections: a review and expert perspective. Expert Rev Anti Infect Ther, 2023, 21(3): 255-265.
16.	Torres A, Garrity-Ryan L, Kirsch C, et al. Omadacycline vs moxifloxacin in adults with community-acquired bacterial pneumonia. Int J Infect Dis, 2021, 104: 501-509.
17.	Wang K, Zhu Y, Xu F, et al. Evaluation of Omadacycline Dosing Regimens in Chinese Using Population Pharmacokinetic-Pharmacodynamic Analysis. Eur J Pharm Sci, 2024, 29: 106713.

1. Huang X, Li D, Liu F, et al. Clinical significance of D-dimer levels in refractory Mycoplasma pneumoniae pneumonia. BMC Infect Dis. 2021, 21(1): 14.
2. Tong L, Huang S, Zheng C, et al. Refractory Mycoplasma pneumoniae pneumonia in children: early recognition and management. J Clin Med. 2022, 11(10): 2824.
3. Meng HY, Dah CY, Chao JW, et al. The clinical significance of and the factors associated with macrolide resistance and poor macrolide response in pediatric Mycoplasma pneumoniae infection: A retrospective study. J Microbiol Immunol Infect, 2023, 56(3): 634-640.
4. Roman S, Monica P, Joven RG, et al. Omadacycline for Community-Acquired Bacterial Pneumonia. N Engl J Med, 2019, 380(6): 517-527.
5. Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U. S. children. N Engl J Med, 2015, 372(9): 835-845.
6. Luo XQ, Luo J, Wang CJ, et al. Clinical features of severe Mycoplasma pneumoniae pneumonia with pulmonary complications in childhood: A retrospective study. Pediatr Pulmonol, 2023, 58(10): 2815-2822.
7. 尹辛大, 郑倩文. 妊娠期重症支原体肺炎并噬血细胞综合征一例并文献复习. 中国呼吸与危重监护杂志, 2022, 21(10): 741-744.
8. Huang X, Gu HY, Wu RX, et al. Chest imaging classification in Mycoplasma pneumoniae pneumonia is associated with its clinical features and outcomes. Respiratory Medicine, 2024, 221: 107480.
9. Tang M, Wang D, Tong X, Wu, et al. Comparison of different detection methods for Mycoplasma pneumoniae infection in children with community-acquired pneumonia. BMC Pediatr, 2021, 21(1): 90-107.
10. Qu JM, Zhang J, Chen Y, et al. Aetiology of severe community acquired pneumonia in adults identified by combined detection methods: a multi-centre prospective study in China. Emerg Microbes Infect, 2022, 11(1): 556-566.
11. Liu ZG, Sun C, Xiao XR, et al. Application of metagenomic next-generation sequencing (mNGS) in diagnosing pneumonia of adults. J Infect Dev Ctries, 2023, 17(11): 1566-1573.
12. Wang N, Zhang H, Yin Y, et al. Antimicrobial susceptibility profiles and genetic characteristics of Mycoplasma pneumoniae in Shanghai, China, from 2017 to 2019. Infect Drug Resist, 2022, 15: 4443-4452.
13. He YS, Yang M, Liu G, et al. Safety study of moxifloxacin in children with severe refractory Mycoplasma pneumoniae pneumonia. Pediatr Pulmonol, 2023, 58(7): 2017-2024.
14. 赵顺英, 钱素云, 陈志敏, 等. 儿童肺炎支原体肺炎诊疗指南(2023年版). 新发传染病电子杂志, 2024, 9(01): 73-79.
15. George S, Nowak M, Geriak M, et al. Omadacycline in treating community-based infections: a review and expert perspective. Expert Rev Anti Infect Ther, 2023, 21(3): 255-265.
16. Torres A, Garrity-Ryan L, Kirsch C, et al. Omadacycline vs moxifloxacin in adults with community-acquired bacterial pneumonia. Int J Infect Dis, 2021, 104: 501-509.
17. Wang K, Zhu Y, Xu F, et al. Evaluation of Omadacycline Dosing Regimens in Chinese Using Population Pharmacokinetic-Pharmacodynamic Analysis. Eur J Pharm Sci, 2024, 29: 106713.

Chinese Journal of Respiratory and Critical Care Medicine

Application of Metagenomic Next-Generation Sequencing Combined with Omadacycline in Refractory Mycoplasma Pneumoniae Pneumonia: Four Cases Report and Literature Review

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