Mycoplasma pneumoniae infections, 11 countries in Europe and Israel, 2011 to 2016

Mycoplasma pneumoniae is a major cause of respiratory infection in humans and macrolide antibiotics, such as azithromycin, are used as the first-line of treatment in many countries. The bacterium is transmitted from person-to-person by respiratory droplets with the incubation period ranging from 4 days to 3 weeks [1]. Because of M. pneumoniae’s intrinsic resistance to many antibiotics, including all cell wall inhibitors, macrolide antibiotics such as azithromycin and clarithromycin are the drug of choice for treatment. In cases of suspected infection in immunocompromised individuals, bactericidal fluoroquinolones may be considered. Tetracyclines are an alternative for treatment of adults with possible macrolide-resistant M. pneumoniae infections. Prudent use of antibiotics has been urged for all cases of M. pneumoniae infection because of worldwide reports of macrolide resistance, which have been reported as ranging from 0.2% in Sweden to more than 90% in China [2-5]. M. pneumoniae infections show seasonal variation. In temperate climates, the number of infections peak during the latter months of the years, with epidemic periods every 4 to 7 years on average [6-8]. The most recent survey in 2012 by Lenglet et al indicated that some countries in the European Union and European Economic Area experienced an increase in M. pneumoniae cases in 2011 whereas others did not, indicating that a universal geographic increase had not occurred [5]. Little is understood about the transmission of M. pneumoniae within populations and several factors have been postulated to account for transmission dynamics, including the immunity level of the population, the bacterial population based on the P1 adhesin type, the age and extent of mixing of children in educational settings. Methodologies for detection of M. pneumoniae include nucleic acid amplification tests (NAAT), serology and culture with varying sensitivities and specificities. There is no international standard material for quality control detection in assays, although ...