Factors associated with Mycoplasma pneumoniae-induced Lobar pneumonia with mucus plugging and the optimal timing for bronchoalveolar lavage: a retrospective study.

Background: Lobar pneumonia with mucus plugging (LPMP) caused by Mycoplasma pneumoniae (MP) is a severe form of community-acquired pneumonia in children, often leading to prolonged disease courses and complications. Identifying clinical factors associated with delayed radiographic resolution and determining the optimal timing for bronchoalveolar lavage (BAL) intervention are crucial for improving clinical outcomes.

Methods: We conducted a retrospective analysis of 151 children aged 2-14 years diagnosed with LPMP between November 2023 and July 2024. Patients were divided into two groups based on radiographic resolution at one month: common resolution (n = 83) and delayed resolution (n = 68). Clinical data, laboratory results, and timing of BAL intervention were compared between groups. Multivariate logistic regression identified independent risk factors of delayed resolution, and receiver operating characteristic (ROC) curves assessed predictive performance.

Results: Children in the delayed resolution group had significantly longer fever durations before intervention (P < 0.001), higher C-reactive protein levels (P < 0.001), and elevated lactate dehydrogenase levels (P < 0.001) compared to the common resolution group. Multivariate analysis identified elevated D-dimer levels (P = 0.010), delayed BAL intervention (P < 0.001), and prolonged hospital stay (P = 0.044) as independent risk factors of delayed resolution. ROC analysis showed that BAL intervention within 6 days had excellent predictive accuracy. Early BAL intervention was associated with shorter hospital stays (P < 0.001), faster cough resolution (P < 0.001), lower incidence of atelectasis at one month (P = 0.024), and higher rates of lung consolidation absorption (P < 0.001).

Conclusion: Elevated D-dimer levels, delayed BAL intervention, and prolonged hospital stay are significant associated with delayed radiographic resolution in children with LPMP. Early BAL intervention within 6 days of admission improves clinical outcomes by accelerating recovery and reducing complications. These findings support prompt BAL as a key component in the management of pediatric LPMP.