Emergence of Mycoplasma pneumoniae before and after COVID-19 pandemic in Germany

Purpose: Mycoplasma (M.) pneumoniae is a common pathogen of community-acquired pneumonia (CAP). Epidemics occur every 3-7 years especially in pediatric patients. We collected data from a large laboratory network in Germany to define the epidemiological dynamics in the pre- and post-COVID-19 pandemic period. Methods: In this retrospective cohort study we included all patients that obtained targeted or multiplex PCR for M. pneumoniae from nasopharyngeal swabs, sputum or bronchoalveolar fluids from 2015 - 2024. Demographic data (age, sex, place of residence, in- or outpatient status) were compared between M. pneumoniae positive and negative patients and co-infections with bacterial or viral pathogens analyzed. Results: We screened 38.204 patients for M. pneumoniae . 1448 cases (3.8 %) of M. pneumoniae were identified (48.8% females). Pediatric patients ≤18 years represented 75.7% of M. pneumoniae patients and 2.3% were ≥60 years. Incidence of M. pneumoniae increased in fourth quartile 2015 (16.2%), second quartile 2018 (14.8%) and fourth quartile 2023 (13.4%). No cases were detected during COVID-19 pandemic 2021. Young age, outpatient status and year of testing were predictors of M. pneumoniae detection in multivariate analysis (p<0.001). Conclusions: Empirical treatment of CAP patients often does not include coverage of M. pneumoniae . A more thorough implementation of available surveillance data into clinical routine, respective therapies could be adapted more quickly during epidemic outbreaks of M. pneumoniae infections.