Analysis of the efficacy and risk factors for poor therapeutic effect of bronchoalveolar lavage at different timings in the treatment of refractory Mycoplasma pneumoniae pneumonia in children

YANG Fang; ZHANG He; JI Hu; AN Hongjiao; CUI Qianqian

doi:10.3969/j.issn.1002-3429.2026.03.006

Abstract：Objective To investigate the efficacy and risk factors for poor therapeutic effect of bronchoalveolar lavage(BAL)at different timings for the treatment of refractory Mycoplasma pneumoniae pneumonia(RMPP)in children.Methods A total of 200 children with RMPP who were admitted from April 2023 to October 2024 were selected.They were divided into the early intervention group(with a disease course of 8 to 14 d),the mid-term intervention group(with a disease course of 15 to 21 d),and the late intervention group(with a disease course of more than 21 d)based on the timing of the first treatment with BAL.The clinical efficacy,duration of fever,duration of cough,time to radiographic resolution,length of hospital stay,and incidence of adverse events after BAL therapy in RMPP children at different timings were compared.Multivariate logistic regression analysis was used to identify the risk factors affecting the poor therapeutic effect of BAL treatment in RMPP children.Results The total effective rate of the early intervention group was 89.36%(84/94),which was higher than that of the mid-term intervention group(77.46%,55/71)and the late intervention group(71.43%,25/35)(P<0.05).The duration of fever,cough,time to radiographic resolution and length of hospital stay in the early intervention group were shorter than those in the mid-term intervention group and the late intervention group(P<0.05).The proportion of shortness of breath,duration of fever,duration of use of Macrolide drugs,proportion of atelectasis,proportion of positive mycoplasma resistance gene loci,proportion of inflammatory stenosis of bronchial lumen under microscopic observation,white blood cell count,C-reactive protein,and duration of disease during BAL treatment were all higher or longer in poor therapeutic effect group than in the good therapeutic effect group(P<0.05).Long duration of fever,high proportion of positive mycoplasma resistance gene loci and long duration of BAL treatment were all independent risk factors affecting the poor therapeutic effect of BAL therapy in children with RMPP(P<0.05).No significant difference was observed in the overall incidence of postoperative adverse events among the three groups(P>0.05).Conclusion Early application of bronchoscopy for BAL therapy can effectively improve the clinical outcomes of children with RMPP.The poor therapeutic effect with BAL is related to the duration of the disease,the presence of positive mycoplasma resistance gene loci,and the disease duration during BAL administration.