Nanopore sequencing enables rapid diagnosis and drug resistance profiling in refractory Mycoplasma pneumoniae pneumonia: a case report.

OBJECTIVE: To evaluate the clinical value of nanopore sequencing technology (NST) for the early diagnosis and resistance guidance of Mycoplasma pneumoniae (MP) infection in children. METHODS: We analyzed four pediatric patients with MP pneumonia. Sputum specimens were subjected to NST, and results were compared with serological MP-IgM testing, nucleic acid detection, and chest CT. RESULTS: In all four cases, MP-IgM yielded false-negative or weakly positive results within the first 5 days. In contrast, NST provided a definitive diagnosis within 24 hours of admission, detecting MP with sequence reads ranging from 14 to 3024 and simultaneously identifying the macrolide-resistant A2063G mutation in the 23S rRNA gene. This led to a confirmed diagnosis 3-7 days earlier than serological methods. Blood cultures were negative in all cases. CONCLUSION: NST overcomes the limitations and delay of traditional methods, enabling rapid and accurate diagnosis of MP infection and concurrent detection of resistance mutations. Its integration into clinical practice may significantly improve the management of pediatric MP pneumonia.