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Hakre S, Sanders-Buell E, Casimier RO, O’Sullivan AM, Peel SA, Tovanabutra S, Scott PT, Okulicz JF. Prevalence of Mycoplasma genitalium Infection and Macrolide and Fluoroquinolone Resistance Mutations Among US Air Force Service Members With HIV, 2016-2020. Open Forum Infect Dis 2024; 11:ofae407. [PMID: 39077051 PMCID: PMC11285372 DOI: 10.1093/ofid/ofae407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/11/2024] [Indexed: 07/31/2024] Open
Abstract
Background Mycoplasma genitalium (MG) infection is a public health concern due to antimicrobial resistance (AMR). Data are limited on repeat MG infection and AMR among US Air Force service members with HIV. Methods US Air Force service members seeking HIV care were screened for MG infection during the surveillance period (16 May 2016-16 March 2020). Baseline and repeat MG prevalence rates were estimated. An extended Cox proportional hazards regression model evaluated characteristics associated with repeat MG infection. MG-positive rectal samples were tested for macrolide or fluoroquinolone resistance. Results Among 299 male patients from a total of 308 patients followed during the surveillance period, baseline prevalence of MG infection was 19.7% (n = 59); among the 101 patients who screened positive for MG at any time during the surveillance period, repeat MG was 35% (n = 36). Characteristics independently associated with increased risk of repeat infection were sexually transmitted infection history vs none (adjusted hazard ratio [aHR], 2.33; 95% CI, 1.26-4.31), a sexually transmitted infection coinfection vs no positive test result in the medical records (aHR, 5.13; 95% CI, 2.78-9.49), and a new HIV diagnosis (<1 vs ≥1 year; aHR, 2.63; 95% CI, 1.45-3.73). AMR in MG-positive rectal specimens was 88% (43/49) indicating macrolide resistance, 18% (10/56) quinolone resistance, and 18% (10/56) both. Conclusions Macrolide and fluoroquinolone resistance mutations were common. Testing for co-occurring MG infection and AMR mutations may be warranted in guiding treatment for sexually transmitted infections such as chlamydia or gonorrhea detected at HIV diagnosis.
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Affiliation(s)
- Shilpa Hakre
- Emerging Infectious Diseases Branch, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- United States Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Eric Sanders-Buell
- United States Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Rosemary O Casimier
- Emerging Infectious Diseases Branch, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Anne Marie O’Sullivan
- United States Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Sheila A Peel
- Diagnostics and Countermeasures Branch, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Sodsai Tovanabutra
- United States Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Paul T Scott
- Emerging Infectious Diseases Branch, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Jason F Okulicz
- Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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Jensen JS, Unemo M. Antimicrobial treatment and resistance in sexually transmitted bacterial infections. Nat Rev Microbiol 2024; 22:435-450. [PMID: 38509173 DOI: 10.1038/s41579-024-01023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/22/2024]
Abstract
Sexually transmitted infections (STIs) have been part of human life since ancient times, and their symptoms affect quality of life, and sequelae are common. Socioeconomic and behavioural trends affect the prevalence of STIs, but the discovery of antimicrobials gave hope for treatment, control of the spread of infection and lower rates of sequelae. This has to some extent been achieved, but increasing antimicrobial resistance and increasing transmission in high-risk sexual networks threaten this progress. For Neisseria gonorrhoeae, the only remaining first-line treatment (with ceftriaxone) is at risk of becoming ineffective, and for Mycoplasma genitalium, for which fewer alternative antimicrobial classes are available, incurable infections have already been reported. For Chlamydia trachomatis, in vitro resistance to first-line tetracyclines and macrolides has never been confirmed despite decades of treatment of this highly prevalent STI. Similarly, Treponema pallidum, the cause of syphilis, has remained susceptible to first-line penicillin.
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Affiliation(s)
- Jorgen S Jensen
- Department of Bacteria, Parasites and Fungi, Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark.
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London, London, UK
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Tsai MJ, Sun HY, Su LH, Lin KY, Liu WD, Huang YS, Chen GJ, Su YC, Liu WC, Chang SY, Hung CC. Mycoplasma genitalium infection and resistance-associated mutations to macrolides and fluoroquinolones among high-risk patients in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024:S1684-1182(24)00081-1. [PMID: 38777653 DOI: 10.1016/j.jmii.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/22/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Mycoplasma genitalium is an emerging etiology of sexually transmitted infections (STIs) with increasing resistance to antimicrobials. Surveillance on the epidemiology of M. genitalium infection and antimicrobial resistance is warranted. METHODS Between September 2021 and August 2023, people with HIV (PWH) and people without HIV (PWoH) at risk of STIs were screened for M. genitalium infection using a multiplex polymerase-chain-reaction assay of specimens collected from the rectum, urethra, oral cavity, and vagina. The prevalences of resistance-associated mutations (RAMs) of M. genitalium to fluoroquinolones, macrolides, and tetracycline were investigated. RESULTS During the 2-year study period, 1021 participants were enrolled, including 531 PWH and 490 PWoH. Overall, 83 (8.1%) and 34 (7.6%) participants had M. genitalium infection at baseline and during follow-up, respectively, with the rectum being the most common site of detection (61.5%). With the first course of antimicrobial treatment, 27 of 63 (42.9%) participants with M. genitalium infection were cured during follow-up, including 24 of 58 (41.4%) who received doxycycline monotherapy. The prevalence of RAMs to macrolides, fluoroquinolones, and tetracyclines at baseline were 24.3%, 22.4%, and 7.9%, respectively. Though PWH had more M. genitalium infection (10.2% vs 5.9%, p = 0.01), a higher rate of RAMs to macrolides (41.0% vs 14.7%, p < 0.01) was found in PWoH. CONCLUSIONS Among high-risk populations, the prevalence of M. genitalium infection was 8.1%. The overall genotypic resistance of M. genitalium to macrolides and fluoroquinolones was moderately high in Taiwan. Detection of M. genitalium infection and antimicrobial resistance is warranted to ensure resistance-guided antimicrobial treatments to be administered.
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Affiliation(s)
- Ming-Jui Tsai
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Hsin Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yin Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Guan-Jhou Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Infection Control Room, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Yi-Ching Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sui-Yuan Chang
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.
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Ljubin-Sternak S, Meštrović T, Marijan T, Anušić M, Šuto S, Vraneš J. Detection of Macrolide and/or Fluoroquinolone Resistance Genes in Mycoplasma genitalium Strains Isolated from Men in the Northwest Region of Croatia in 2018-2023. Genes (Basel) 2024; 15:470. [PMID: 38674404 PMCID: PMC11049799 DOI: 10.3390/genes15040470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Mycoplasma genitalium (M. genitalium) poses a significant public health challenge due to its association with non-gonococcal urethritis (particularly in men) and antimicrobial resistance. However, despite the prevalence of M. genitalium infections and the rise in resistance rates, routine testing and surveillance remain limited. This is the first study from Croatia that aimed to assess the prevalence and trends of resistance in M. genitalium strains isolated from male individuals by detecting macrolide and fluoroquinolone resistance genes. The study also aimed to explore the factors associated with resistance and changes in resistance patterns over time. Urine samples collected from male individuals in the Zagreb County and northwest region of Croatia between 2018 and 2023 were tested for M. genitalium with the use of molecular methods. Positive samples were subjected to DNA extraction and multiplex tandem polymerase chain reaction (MT-PCR) targeting genetic mutations associated with macrolide (23S rRNA gene) and fluoroquinolone (parC gene) resistance. Of the 8073 urine samples tested from 6480 male individuals (and following the exclusion of repeated specimens), we found that the prevalence of M. genitalium infection was 2.2%. Macrolide resistance was observed in 60.4% of strains, while fluoroquinolone resistance was found in 19.2%. Co-resistance to both antibiotics was present in 18.2% of cases. A statistically significant increase in fluoroquinolone resistance was noted over the study period (p = 0.010), but this was not evident for azithromycin resistance (p = 0.165). There were no statistically significant differences in resistance patterns between age groups, whereas re-testing of patients revealed dynamic changes in resistance profiles over time. The high burden of macrolide resistance and increasing fluoroquinolone resistance underscore the urgent need for comprehensive resistance testing and surveillance programs. The implementation of resistance-guided treatment strategies, along with enhanced access to molecular diagnostics, is pivotal for effectively managing M. genitalium infections.
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Affiliation(s)
- Sunčanica Ljubin-Sternak
- Clinical Microbiology Department, Teaching Institute of Public Health “Dr Andrija Štampar”, 10000 Zagreb, Croatia; (T.M.); (M.A.); (S.Š.); (J.V.)
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Meštrović
- University Centre Varaždin, University North, 42000 Varaždin, Croatia;
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Tatjana Marijan
- Clinical Microbiology Department, Teaching Institute of Public Health “Dr Andrija Štampar”, 10000 Zagreb, Croatia; (T.M.); (M.A.); (S.Š.); (J.V.)
| | - Maja Anušić
- Clinical Microbiology Department, Teaching Institute of Public Health “Dr Andrija Štampar”, 10000 Zagreb, Croatia; (T.M.); (M.A.); (S.Š.); (J.V.)
| | - Sandra Šuto
- Clinical Microbiology Department, Teaching Institute of Public Health “Dr Andrija Štampar”, 10000 Zagreb, Croatia; (T.M.); (M.A.); (S.Š.); (J.V.)
| | - Jasmina Vraneš
- Clinical Microbiology Department, Teaching Institute of Public Health “Dr Andrija Štampar”, 10000 Zagreb, Croatia; (T.M.); (M.A.); (S.Š.); (J.V.)
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Chiribau CB, Schmedes S, Dong Y, Tarigopula N, Tekin O, Cannons A, Roberts J, Haiduven D, Crowe SR. Detection of resistance to macrolides and fluoroquinolones in Mycoplasma genitalium by targeted next-generation sequencing. Microbiol Spectr 2024; 12:e0384523. [PMID: 38349187 PMCID: PMC10913745 DOI: 10.1128/spectrum.03845-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 03/07/2024] Open
Abstract
Mycoplasma genitalium is fastidious to culture, and its detection in human clinical specimens relies mainly on molecular methods. Phenotypic determination of antibiotic susceptibility for this bacterium is not a timely or feasible option for most clinical laboratories. This study sought to determine whether next-generation sequencing technologies can effectively be employed in determining genetic mutations associated with drug resistance in M. genitalium samples collected in Aptima Hologic tubes and possibly integrating them into viable workflows in public health laboratories. Following analysis by a custom-designed bioinformatics pipeline, at least one mutation/sample has been identified in 94/98 specimens in at least one of seven loci (macrolides: rrl, rplD, rplV; fluoroquinolones: parC, parE, gyrA, gyrB) described previously to be connected to antibiotic resistance. This method identified a total of 469 single nucleotide polymorphisms (SNPs) (452 mutations): 134 of 23S rRNA SNPs and 318 amino acid mutations: 114 substitutions and 204 synonymous; the turnaround time (sample to analyzed sequence) was typically 3 days. The assays and workflows described in this work demonstrated that the determination of a drug resistance profile for macrolides and fluoroquinolones of M. genitalium samples by using next-generation sequencing in clinical samples is a feasible approach that can be implemented in clinical laboratories, following thorough and extensive validation studies.IMPORTANCEThe mechanisms of drug resistance in Mycoplasma genitalium are complex and involve several genetic loci. The molecular methods for accurately characterizing resistance to fluoroquinolones and macrolides in this organism are often not available or approved for patient use and do not cover all genetic determinants. To this end, we propose a next-generation sequencing-based method with a turnaround time of 3 days that includes the investigation of all drug resistance loci of M. genitalium. Following adaptation, validation, and verification for routine clinical use, assays based on this method may yield molecular results that can be used to guide proper treatment regimens and for surveillance of drug resistance in the general population.
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Affiliation(s)
- Calin B. Chiribau
- Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, Florida, USA
| | - Sarah Schmedes
- Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, Florida, USA
| | - Yibo Dong
- Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, Florida, USA
| | - Namratha Tarigopula
- Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, Florida, USA
| | - Omer Tekin
- Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, Florida, USA
| | - Andrew Cannons
- University of South Florida, College of Public Health, Tampa, Florida, USA
| | - Jill Roberts
- University of South Florida, College of Public Health, Tampa, Florida, USA
| | - Donna Haiduven
- University of South Florida, College of Public Health, Tampa, Florida, USA
| | - Susanne R. Crowe
- Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, Florida, USA
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De Baetselier I, Smet H, Kehoe K, Loosen I, Reynders M, Mansoor I, Filippin L, Cauchie M, Van Even E, Makki N, Schiettekatte G, Vandewal W, Glibert B, Matheeussen V, Van der Beken Y, Cartuyvels R, Steyaert S, Lemmens A, Garrino MG, Paridaens H, Lazarova E, Lissoir B, Deffontaine M, Heinrichs A, Saegeman V, Padalko E, Lecompte A, Vanden Berghe W, Kenyon C, Van den Bossche D. Estimation of antimicrobial resistance of Mycoplasma genitalium, Belgium, 2022. Euro Surveill 2024; 29:2300318. [PMID: 38362626 PMCID: PMC10986661 DOI: 10.2807/1560-7917.es.2024.29.7.2300318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/25/2023] [Indexed: 02/17/2024] Open
Abstract
BackgroundAntimicrobial resistance (AMR) of Mycoplasma genitalium (MG) is a growing concern worldwide and surveillance is needed. In Belgium, samples are sent to the National Reference Centre of Sexually Transmitted Infections (NRC-STI) on a voluntary basis and representative or robust national AMR data are lacking.AimWe aimed to estimate the occurrence of resistant MG in Belgium.MethodsBetween July and November 2022, frozen remnants of MG-positive samples from 21 Belgian laboratories were analysed at the NRC-STI. Macrolide and fluoroquinolone resistance-associated mutations (RAMs) were assessed using Sanger sequencing of the 23SrRNA and parC gene. Differences in resistance patterns were correlated with surveillance methodology, socio-demographic and behavioural variables via Fisher's exact test and logistic regression analysis.ResultsOf the 244 MG-positive samples received, 232 could be sequenced for macrolide and fluoroquinolone RAMs. Over half of the sequenced samples (55.2%) were resistant to macrolides. All sequenced samples from men who have sex with men (MSM) (24/24) were macrolide-resistant. Fluoroquinolone RAMs were found in 25.9% of the samples and occurrence did not differ between socio-demographic and sexual behaviour characteristics.ConclusionAlthough limited in sample size, our data suggest no additional benefit of testing MG retrieved from MSM for macrolide resistance in Belgium, when making treatment decisions. The lower occurrence of macrolide resistance in other population groups, combined with emergence of fluoroquinolone RAMs support macrolide-resistance testing in these groups. Continued surveillance of resistance in MG in different population groups will be crucial to confirm our findings and to guide national testing and treatment strategies.
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Affiliation(s)
- Irith De Baetselier
- National Reference Centre of Sexually Transmitted Infections Belgium, Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
| | - Hilde Smet
- National Reference Centre of Sexually Transmitted Infections Belgium, Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
| | - Kaat Kehoe
- Algemeen Medisch Laboratorium, Antwerp, Belgium
| | | | - Marijke Reynders
- AZ (General Hospital) Sint-Jan Brugge-Oostende AV, Laboratory Medicine, Molecular Microbiology, Bruges, Belgium
| | | | | | | | - Ellen Van Even
- Clinical Laboratory of Microbiology, Heilig Hart (HH) Hospital Lier, Lier, Belgium
| | - Nadia Makki
- Algemeen Medisch Laboratorium, Antwerp, Belgium
| | | | | | | | - Veerle Matheeussen
- Department of Microbiology, University Hospital Antwerp, Edegem, Belgium
| | | | | | | | - Ann Lemmens
- AZ Sint-Maarten Hospital, Department Clinical Microbiology, Mechelen, Belgium
| | | | - Henry Paridaens
- Laboratory of Molecular Biology, Citadelle Hospital, Liege, Belgium
| | - Elena Lazarova
- Clinical laboratory, Regional Hospital de la Haute Senne, Soignies, Belgium
| | | | - Marine Deffontaine
- Laboratoire de Biologie Clinique, Centre Hospitalier de Mouscron, Mouscron, Belgium
| | - Amélie Heinrichs
- Laboratory of Clinical Biology, Hospital Arlon, Vivalia, Arlon, Belgium
| | | | - Elizaveta Padalko
- Ghent University Hospital, Department of Laboratory Medicine, Ghent, Belgium
| | - Amaryl Lecompte
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Wim Vanden Berghe
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Chris Kenyon
- STI Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dorien Van den Bossche
- National Reference Centre of Sexually Transmitted Infections Belgium, Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
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Drud ST, Anagrius C, Loré B, Elfving K, Jensen JS. Changes in prevalence of Mycoplasma genitalium macrolide and fluoroquinolone resistance: notes from a 13-year retrospective survey in Dalarna County, Sweden. Sex Transm Infect 2023; 99:507-512. [PMID: 37704364 DOI: 10.1136/sextrans-2023-055900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/10/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE Macrolide and fluoroquinolone resistance in Mycoplasma genitalium (MG) is of emerging global concern. Compared with neighbouring countries such as Denmark, Sweden has had lower rates of macrolide resistance while fluoroquinolone resistance rates are less well documented. This study retrospectively examined macrolide, fluoroquinolone and multidrug resistance rates from Dalarna County, Sweden over a 13-year period. METHODS MG-positive samples from 2006 to 2018 from patients examined at the Department of Venereology, Central Hospital, Falun, Sweden were tested by sequencing for macrolide resistance mutations (MRM) and fluoroquinolone resistance-associated mutations (QRAM) in the parC and gyrA subunit regions. A subset of these samples from 2006 to 2011 have been reported on previously, although only for MRM. RESULTS Of 874 samples, 98 (11.2%, 95% CI 9.1% to 13.6%) had mutations associated with resistance to macrolides and 19 of 828 (2.3%, 95% CI 8.9% to 23.1%) to quinolones. Mutations associated with resistance to both drugs were detected in 5 of 828 (0.6%, 95% CI 0.1% to 1.4%) samples overall. A significant positive linear trend (p=0.004) for an increase in the rate of macrolide resistance was observed (from 0% in 2006 to 31% in 2018) while the increase in QRAM from 0% in 2006 to 12.3% in 2018 was not statistically significant. CONCLUSIONS Despite a decrease in macrolide and fluoroquinolone consumption in Sweden, there was an overall increase in MG macrolide, fluoroquinolone and dual resistance from 2006 to 2018, although the difference in fluoroquinolone resistance rates was not statistically significant. In order to maintain comparably low resistance rates, resistance-guided therapy for MG infections will be crucial.
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Affiliation(s)
- Suhella Tulsiani Drud
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Kobenhavn, Denmark
| | | | - Britta Loré
- Department of Clinical Microbiology, Falu lasarett, Falun, Sweden
| | - Karin Elfving
- Department of Clinical Microbiology, Laboratory Medicine, Falu lasarett, Falun, Sweden
| | - Jørgen Skov Jensen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Kobenhavn, Denmark
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8
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Peris MP, Dehesa B, Alonso H, Escolar C, Clusa L, Latorre-Millán M, Rezusta A, Milagro A. Retrospective and Comparative Study of Three Molecular Assays for the Macrolide Resistance Detection in Mycoplasma genitalium Positive Urogenital Specimens. Int J Mol Sci 2023; 24:ijms24087218. [PMID: 37108385 PMCID: PMC10138598 DOI: 10.3390/ijms24087218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The capacity of Mycoplasma genitalium to develop resistance to macrolides makes detection of macrolide resistance genes by rapid real-time PCR assays increasingly necessary in clinical diagnostic laboratories so as to initiate appropriate treatment as rapidly as possible. The aim of this retrospective and comparative study was to conduct the clinical evaluation of three commercially available kits for macrolide resistance detection. A total of 111 M. genitalium positive samples analyzed in the Clinical Microbiology Laboratory of the Miguel Servet University Hospital, Zaragoza (Spain) were used. After M. genitalium molecular confirmation, the three assays under study were evaluated and discrepant results were resolved via sequencing. The clinical sensitivity for resistance detection was 83% (95% confidence interval, 69% to 93%) for the ResistancePlus® MG panel kit (SpeeDx Pty Ltd., Sydney, Australia), 95% (84% to 99%) for AllplexTM MG & AziR Assay (Seegene®, Seoul, Korea), and 97% (88% to 99%) for the VIASURE macrolide resistance-associated mutations (23SrRNA) Real time PCR detection kit (Certest Biotec, Zaragoza, Spain). The clinical specificity was 100% (94% to 100%) for Allplex and VIASURE assays and 95% (86% to 99%) for SpeeDx assay. The results arising from this study are cause for strong consideration for the implementation of rapid real-time PCR assays in clinical diagnosis laboratories to eliminate treatment failure and transmission as soon as possible.
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Affiliation(s)
- María Paz Peris
- Instituto de Investigación Sanitaria Aragón, 50009 Zaragoza, Spain
- Department of Animal Pathology, Faculty of Veterinary, University of Zaragoza, 50013 Zaragoza, Spain
| | - Blanca Dehesa
- Department of Microbiology, Pediatrics, Radiology, and Public Health, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Henar Alonso
- Department of Microbiology, Pediatrics, Radiology, and Public Health, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Cristina Escolar
- Department of Animal Production and Food Science, Faculty of Veterinary, University of Zaragoza, 50013 Zaragoza, Spain
| | - Laura Clusa
- Instituto de Investigación Sanitaria Aragón, 50009 Zaragoza, Spain
| | | | - Antonio Rezusta
- Instituto de Investigación Sanitaria Aragón, 50009 Zaragoza, Spain
- Miguel Servet University Hospital, Microbiology, 50009 Zaragoza, Spain
| | - Ana Milagro
- Instituto de Investigación Sanitaria Aragón, 50009 Zaragoza, Spain
- Miguel Servet University Hospital, Microbiology, 50009 Zaragoza, Spain
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9
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Edelstein IA, Guschin AE, Romanov AV, Negasheva ES, Kozlov RS. Genetic Determinants of Macrolide and Fluoroquinolone Resistance in Mycoplasma genitalium and Their Prevalence in Moscow, Russia. Pathogens 2023; 12:pathogens12030496. [PMID: 36986417 PMCID: PMC10058343 DOI: 10.3390/pathogens12030496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Macrolide (MLR) and fluoroquinolone (FQR) resistance in Mycoplasma genitalium (MG) has recently become a major problem worldwide. The available data on the prevalence of MLR and FQR in MG in Russia are limited. In this study, we aimed to evaluate the prevalence and pattern of mutations in 213 MG-positive urogenital swabs from patients in Moscow between March 2021 and March 2022. MLR- and FQR-associated mutations were searched in 23S rRNA as well as in the parC and gyrA genes using Sanger sequencing. The prevalence of MLR was 55/213 (26%), with A2059G and A2058G substitutions being the two most common variants (36/55, 65%, and 19/55, 35%, respectively). FQR detection showed 17% (37/213); two major variants were D84N (20/37, 54%) and S80I (12/37, 32.4%) and three minor variants were S80N (3/37, 8.1%), D84G (1/37, 2.7%), and D84Y (1/37, 2.7%). Fifteen of the fifty-five MLR cases (27%) simultaneously harbored FQR. This study revealed the high frequency of MLR and FQR. We conclude that the improvement of patient examination algorithms and therapeutic approaches should be combined with the routine monitoring of antibiotic resistance based on the sensitivity profiles presented. Such a complex approach will be essential for restraining the development of treatment resistance in MG.
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Affiliation(s)
- Inna Alexandrovna Edelstein
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University of the Ministry of Health of the Russian Federation, 214019 Smolensk, Russia
| | | | - Andrew Vyacheslavovich Romanov
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University of the Ministry of Health of the Russian Federation, 214019 Smolensk, Russia
| | | | - Roman Sergeevich Kozlov
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University of the Ministry of Health of the Russian Federation, 214019 Smolensk, Russia
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10
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Shipitsyna E, Kularatne R, Golparian D, Müller EE, Vargas SK, Hadad R, Padovese V, Hancali A, Alvarez CS, Oumzil H, Camey E, Blondeel K, Toskin I, Unemo M. Mycoplasma genitalium prevalence, antimicrobial resistance-associated mutations, and coinfections with non-viral sexually transmitted infections in high-risk populations in Guatemala, Malta, Morocco, Peru and South Africa, 2019-2021. Front Microbiol 2023; 14:1130762. [PMID: 36910203 PMCID: PMC9994645 DOI: 10.3389/fmicb.2023.1130762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
The prevalence of Mycoplasma genitalium (MG) and MG antimicrobial resistance (AMR) appear to be high internationally, however, prevalence data remain lacking globally. We evaluated the prevalence of MG and MG AMR-associated mutations in men who have sex with men (MSM) in Malta and Peru and women at-risk for sexually transmitted infections in Guatemala, South Africa, and Morocco; five countries in four WHO regions mostly lacking MG prevalence and AMR data, and estimated MG coinfections with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV). Male urine and anorectal samples, and vaginal samples were tested for MG, CT, NG, and TV (only vaginal samples) using Aptima assays (Hologic). AMR-associated mutations in the MG 23S rRNA gene and parC gene were identified using ResistancePlus MG kit (SpeeDx) or Sanger sequencing. In total, 1,425 MSM and 1,398 women at-risk were recruited. MG was detected in 14.7% of MSM (10.0% in Malta and 20.0% Peru) and in 19.1% of women at-risk (12.4% in Guatemala, 16.0% Morocco, 22.1% South Africa). The prevalence of 23S rRNA and parC mutations among MSM was 68.1 and 29.0% (Malta), and 65.9 and 5.6% (Peru), respectively. Among women at-risk, 23S rRNA and parC mutations were revealed in 4.8 and 0% (Guatemala), 11.6 and 6.7% (Morocco), and 2.4 and 3.7% (South Africa), respectively. CT was the most frequent single coinfection with MG (in 2.6% of MSM and 4.5% of women at-risk), compared to NG + MG found in 1.3 and 1.0%, respectively, and TV + MG detected in 2.8% of women at-risk. In conclusion, MG is prevalent worldwide and enhanced aetiological MG diagnosis, linked to clinical routine detection of 23S rRNA mutations, in symptomatic patients should be implemented, where feasible. Surveillance of MG AMR and treatment outcome would be exceedingly valuable, nationally and internationally. High levels of AMR in MSM support avoiding screening for and treatment of MG in asymptomatic MSM and general population. Ultimately, novel therapeutic antimicrobials and/or strategies, such as resistance-guided sequential therapy, and ideally an effective MG vaccine are essential.
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Affiliation(s)
- Elena Shipitsyna
- World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russia
| | - Ranmini Kularatne
- Labtests Laboratory and Head Office, Mt Wellington, Auckland, New Zealand.,Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Golparian
- World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Etienne E Müller
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Silver K Vargas
- School of Public Health and Administration, Centre for Interdisciplinary Investigation in Sexuality, AIDS, Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ronza Hadad
- World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Valeska Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Amina Hancali
- STIs Laboratory, National Institute of Hygiene, Ministry of Health, Rabat, Morocco
| | | | - Hicham Oumzil
- STIs Laboratory, National Institute of Hygiene, Ministry of Health, Rabat, Morocco.,Faculty of Medicine and Pharmacy, University Mohamed V, Rabat, Morocco
| | - Elsy Camey
- Sida y Sociedad ONG (SISO), Escuintla, Guatemala
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Magnus Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Institute for Global Health, University College London (UCL), London, United Kingdom
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11
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Piñeiro L, Idigoras P, Arrastia M, Manzanal A, Ansa I, Cilla G. Increases in the Macrolide Resistance of Mycoplasma genitalium and the Emergence of the A2058T Mutation in the 23S rRNA Gene: Clonal Spread? Antibiotics (Basel) 2022; 11:antibiotics11111492. [PMID: 36358147 PMCID: PMC9686820 DOI: 10.3390/antibiotics11111492] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
The management of Mycoplasma genitalium sexually transmitted infection (STI) is hindered by increasing resistance to the recommended antibiotics, macrolides and quinolones, worldwide. In Gipuzkoa (Basque Country, Spain), macrolide and quinolone resistance rates in 2014−2018 were reported as <20% and <10%, respectively. The aims of this study were to compare these rates with those in 2019−2021 and analyse the genetic and epidemiological features of the strains and cases associated with striking changes in the resistance trends. Resistance to macrolides (n = 1019) and quinolones (n = 958) was studied, analysing mutations in 23S rRNA and parC/gyrA genes, respectively. The rate of macrolide resistance increased from 17.3% in 2014−2018 to 32.1% in 2019−2021, as much in the more prevalent A2058/2059G mutations (16.6−27.8%) as in the emergent A2058T mutations (0.5−4.1%) but with differences in the odds ratios and the relative risk increase between A2058T and A2058/2059G mutations. MG191 adhesin and MG309 lipoprotein of the 27 emergent strains detected with A2058T mutations were amplified, sequenced, and typed using phylogenetic and variable number tandem repeat analysis, respectively. Genetic clonal spread was ruled out, but most of the A2058T cases were men who had sex with men (24/27) with a history of STI and antibiotic treatments (19/27). No changes were observed in quinolone resistance trends, but the rate of resistance to both antibiotics rose from 2.9% to 8.3%, especially in cases with A2058T mutations. The genetic characterisation of strains and epidemiological surveillance of cases are needed to detect populations at increased risk of treatment failure in this infection.
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Affiliation(s)
- Luis Piñeiro
- Microbiology Department, Donostia University Hospital, 20014 Donostia, Spain
- Biodonostia Health Research Institute, 20014 Donostia, Spain
- Correspondence:
| | - Pedro Idigoras
- Microbiology Department, Donostia University Hospital, 20014 Donostia, Spain
| | - Maitane Arrastia
- Microbiology Department, Donostia University Hospital, 20014 Donostia, Spain
| | - Ayla Manzanal
- Microbiology Department, Donostia University Hospital, 20014 Donostia, Spain
| | - Iñigo Ansa
- Microbiology Department, Donostia University Hospital, 20014 Donostia, Spain
| | - Gustavo Cilla
- Microbiology Department, Donostia University Hospital, 20014 Donostia, Spain
- Biodonostia Health Research Institute, 20014 Donostia, Spain
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12
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Pitt R, Boampong D, Day M, Jensen JS, Cole M. Challenges of in vitro propagation and antimicrobial susceptibility testing of Mycoplasma genitalium. J Antimicrob Chemother 2022; 77:2901-2907. [PMID: 35979812 DOI: 10.1093/jac/dkac281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The sexually transmitted bacterial pathogen Mycoplasma genitalium has proved a complex organism to work with in the laboratory setting. Exhibiting an extremely fastidious nature, successful in vitro propagation of M. genitalium has remained elusive for many researchers. Antimicrobial resistance to both first- and second-line recommended therapies (macrolides and fluoroquinolones, respectively) is commonly reported. However, phenotypic susceptibility testing is not routinely performed, due to the difficulties of in vitro growth. Instead, molecular detection of known resistance determinants is used to infer susceptibility/resistance. However, associations between determinant detection and clinical treatment failure are not always clear. Furthermore, molecular assays have limited use for detection of emerging resistance mechanisms. The present review collates and discusses the development of successful culture systems for initial isolation of this organism and current methodologies employed for phenotypic susceptibility testing to aid researchers in this field. As with Neisseria gonorrhoeae, future treatment options are extremely limited for M. genitalium and, if this sexually transmitted infection is to remain treatable, phenotypic susceptibility testing will play an invaluable role in evaluation of potential therapeutics. As such, retainment of these techniques is imperative.
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Affiliation(s)
- Rachel Pitt
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | | | - Michaela Day
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | | | - Michelle Cole
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
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13
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Mahlangu MP, Müller EE, Da Costa Dias B, Venter JME, Kularatne RS. Molecular Characterization and Detection of Macrolide and Fluoroquinolone Resistance Determinants in Mycoplasma genitalium in South Africa, 2015 to 2018. Sex Transm Dis 2022; 49:511-516. [PMID: 35312667 DOI: 10.1097/olq.0000000000001631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antimicrobial resistance in Mycoplasma genitalium is a global concern, as therapeutic options are limited. We aimed to determine the prevalence of macrolide and fluoroquinolone resistance-associated genetic determinants and strain diversity in M. genitalium-positive surveillance specimens from symptomatic primary health care center attendees in South Africa (2015-2018). A secondary objective was to investigate for an association between M. genitalium strain type, HIV serostatus, and antimicrobial resistance. METHODS A total of 196 M. genitalium-positive specimens from adult males and females presenting with genital discharge to primary health care centers were tested for resistance-associated mutations in 23S rRNA, parC and gyrA. A dual-locus sequence type (DLST) was assigned to M. genitalium strains based on the detection of single nucleotide polymorphisms in the semiconserved 5' region of the mgpB gene (MG191-sequence typing) as well as the enumeration of short tandem repeats within the lipoprotein gene (MG309 short tandem repeat typing). RESULTS The A2059G mutation in 23S rRNA, associated with macrolide resistance, was detected in 3 of 182 specimens (1.7%; 95% confidence interval, 0.3-4.7). We did not detect gyrA or parC mutations associated with fluoroquinolone resistance in specimens that could be sequenced. Molecular typing with DLST revealed genetic heterogeneity, with DLST 4-11 being the most common M. genitalium strain type detected. There were no associations between DLST and macrolide resistance or HIV infection. CONCLUSIONS We found a low prevalence of M. genitalium strains with macrolide resistance-associated mutations over a 4-year surveillance period. Ongoing antimicrobial resistance surveillance is essential for informing genital discharge syndromic treatment guidelines.
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Affiliation(s)
- Mahlape P Mahlangu
- From the Sexually Transmitted Infections Section, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS)
| | - Etienne E Müller
- From the Sexually Transmitted Infections Section, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS)
| | - Bianca Da Costa Dias
- From the Sexually Transmitted Infections Section, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS)
| | - Johanna M E Venter
- From the Sexually Transmitted Infections Section, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS)
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14
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De Baetselier I, Vuylsteke B, Reyniers T, Smet H, Van den Bossche D, Kenyon C, Crucitti T. Worryingly high prevalence of resistance-associated mutations to macrolides and fluoroquinolones in Mycoplasma genitalium among men who have sex with men with recurrent sexually transmitted infections. Int J STD AIDS 2022; 33:385-390. [DOI: 10.1177/09564624211070704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Men who have sex with men (MSM) using pre-exposure prophylaxis (PrEP) recurrently infected with STIs are playing a pivotal role in contemporary Sexually transmitted infections (STI) epidemics. Our aim was to assess whether these individuals had more Mycoplasma genitalium ( M. genitalium) infections and more resistance to macrolides and fluoroquinolones of M. genitalium compared to those who were not recurrently infected with STIs. Methods The study was performed on 179 Belgian MSM PrEP users that were followed up for 18 months. STIs including M. genitalium were detected quarterly. Detection of resistance-associated mutations (RAMs) to macrolides and fluoroquinolones was performed via Sanger sequencing of the 23S rRNA gene and parC gene (conferring mutations at position 83/87 in ParC). Differences in M. genitalium positivity rate and presence of RAMs between both groups were assessed using mixed-effects logistic regression. Results A total of 91 new M. genitalium infections were detected among 70 participants. MSM experiencing recurrent STIs have significantly more M. genitalium infections compared to those without (11.7% vs. 4.7% OR: 2.69). Importantly, the prevalence of RAMs to macrolides (95.2% vs. 77.4%) and fluoroquinolones (35.7% vs. 12.9%) was much higher among individuals with recurrent STIs. The difference was only statistically significant for macrolides (OR 5.83, p = .036). Conclusions MSM recurrently infected with STIs play a central role in the emergence of antimicrobial resistance in M. genitalium. The use of macrolides and fluoroquinolones should preferably be minimized in this population in order to avoid further emergence of multi-resistant M. genitalium.
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Affiliation(s)
- Irith De Baetselier
- Clinical Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bea Vuylsteke
- HIV/STI Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Thijs Reyniers
- HIV/STI Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Hilde Smet
- Clinical Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Dorien Van den Bossche
- Clinical Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Chris Kenyon
- STI Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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15
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Lee SS, Cheng KF, Wong NS, Kwan CK, Lau OC, Cheng HF, Ngan W, Ma SP, Kam KM, Ho KM, Chung PH, Chan DPC. The emergence of antibiotic resistant Mycoplasma genitalium as the cause of non-gonococcal urethritis in male sexually transmitted infection clinic patients. Int J Antimicrob Agents 2021; 59:106510. [PMID: 34971729 DOI: 10.1016/j.ijantimicag.2021.106510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
Mycoplasma genitalium (MG) is the cause of an emerging sexually-acquired infection with high propensity for antimicrobial resistance development. In a prevalence study conducted at the public sexually transmitted infection (STI) service in Hong Kong, the first void urine (FVU) samples of 38 (8%) out of 493 male non-gonococcal urethritis (NGU) patients were tested positive by RT-PCR. Patients with MG were younger in age (31 vs 33, OR=0.96, 95% CI 0.93-0.996; P=0.03), more likely to present with urethral discharge (12% vs 6%, OR=2.16, 95% CI 1.10-4.23; P=0.02) and had longer symptom duration of over 2 weeks (14% vs 6%, OR=2.34, 95% CI 1.10-4.97; P=0.03). The prevalence of MG was lower in patients co-infected with Chlamydia trachomatis than as isolated infection (4% vs 10%, OR=0.38, 95% CI 0.17-0.84; P=0.02). Men who have sex with men (MSM) did not give a higher prevalence of MG. Antimicrobial resistance-conferring mutation was present in 24 (63%) patients with MG - 23S rRNA 18 (47%) and parC 19 (53%). Similar to neigbouring Asia Pacific countries, concurrent resistance mutation against both macrolide and fluoroquinolone was demonstrated in 14 (37%). Histories of azithromycin and moxifloxacin use were significantly associated with MG diagnosis. Characteristically, NGU in Hong Kong featured the co-existence of mono-resistance against macrolide or fluoroquinolone, and the presence of dual class resistance. The geographic variability of antimicrobial resistance against MG is attributed to not just the different transmission networks formed in separate population groups but the antimicrobial prescriptions in the treatment of urethritis in the community.
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Affiliation(s)
- Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kim Fung Cheng
- Social Hygiene Service, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region Government, Hong Kong, China
| | - Ngai Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Chi Keung Kwan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - On Cheung Lau
- Social Hygiene Service, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region Government, Hong Kong, China
| | - Hok Fai Cheng
- Social Hygiene Service, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region Government, Hong Kong, China
| | - William Ngan
- Social Hygiene Service, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region Government, Hong Kong, China
| | - Siu Pang Ma
- Social Hygiene Service, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region Government, Hong Kong, China
| | - Kai Man Kam
- Precious Blood Hospital (Caritas), Kowloon, Hong Kong, China
| | - King Man Ho
- Social Hygiene Service, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region Government, Hong Kong, China
| | - Pui Hong Chung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Denise Pui Chung Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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16
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Fifer H, Merrick R, Pitt R, Yung M, Allen H, Day M, Sinka K, Woodford N, Mohammed H, Brown CS, Hughes G, Cole M. Frequency and Correlates of Mycoplasma genitalium Antimicrobial Resistance Mutations and Their Association With Treatment Outcomes: Findings From a National Sentinel Surveillance Pilot in England. Sex Transm Dis 2021; 48:951-954. [PMID: 34108410 DOI: 10.1097/olq.0000000000001493] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mycoplasma genitalium infection is a public health concern due to extensive antimicrobial resistance. Using data from a pilot of M. genitalium antimicrobial resistance surveillance, we determined the prevalence and risk factors for resistance among specimens from sexual health clinic attendees and assessed treatment outcomes. METHODS Seventeen sexual health clinics in England sent consecutive M. genitalium-positive specimens to the national reference laboratory from January to March 2019. Regions of the 23S rRNA, parC, and gyrA genes associated with macrolide and fluoroquinolone resistance, respectively, were amplified and sequenced where appropriate. Fisher exact tests, and univariate and multivariable logistic regression models were used to determine associations between demographic, clinical, and behavioral factors and resistance-associated mutations. RESULTS More than two-thirds (173 of 249 [69%]) of M. genitalium specimens had mutations associated with macrolide resistance, whereas predicted fluoroquinolone (21 of 251 [8%]) and dual-drug (12 of 237 [5%]) resistance were less prevalent. No specimens had both gyrA and parC resistance-associated mutations. Macrolide resistance was more common in specimens from men who have sex with men compared with heterosexual men (adjusted odds ratio, 2.64; 95% confidence interval, 1.09-6.38; P = 0.03). There was an association between both macrolide and fluoroquinolone resistance and having a previous sexually transmitted infection (P = 0.06).Only 19% of individuals returned for a test of cure. Of those infected with a macrolide-resistant genotype who were given azithromycin, 57 of 78 (73%) were known or assumed to be clinically cured; however, 43 of these 57 (75%) also received doxycycline. Of the 21 with a macrolide-resistant genotype who failed treatment, 18 of 21 (86%) also received doxycycline. CONCLUSIONS Although macrolide resistance was widespread, particularly among specimens from men who have sex with men and those with a previous sexually transmitted infection diagnosis in the past year, resistance-associated mutations in M. genitalium did not seem to be unequivocally predictive of treatment failure.
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Affiliation(s)
- Helen Fifer
- From the National Infection Service, Public Health England, London, United Kingdom
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17
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Chua TP, Bodiyabadu K, Machalek DA, Garland SM, Bradshaw CS, Plummer EL, Danielewski J, Vodstrcil LA, Doyle ML, Murray GL. Prevalence of Mycoplasma genitalium fluoroquinolone-resistance markers, and dual-class-resistance markers, in asymptomatic men who have sex with men. J Med Microbiol 2021; 70. [PMID: 34590993 PMCID: PMC8697509 DOI: 10.1099/jmm.0.001429] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Failure of fluoroquinolones, the principal treatment option for macrolide-resistant Mycoplasma genitalium infections, has recently emerged. This is of particular concern for men who have sex with men (MSM), who have high proportions of macrolide-resistant M. genitalium infections. Treatment failure with moxifloxacin is likely the result of single nucleotide polymorphisms (SNPs) in parC, whilst concurrent gyrA mutations may play a role.Gap Statement. The levels of fluoroquinolone resistance and dual-class (i.e. macrolide and fluoroquinolone) resistance in M. genitalium among asymptomatic MSM is unknown.Aim. To (i) determine the proportion of fluoroquinolone resistance and dual-class resistance in M. genitalium infections among asymptomatic MSM, (ii) explore any clinical and behavioural associations with fluoroquinolone resistance, and (iii) determine the distribution of antibiotic resistance among M. genitalium mgpB sequence types (STs).Methodology. M. genitalium positive samples (N=94) were obtained from 1001 asymptomatic MSM enrolled in a study at Melbourne Sexual Health Centre (Carlton, Australia) between August 2016 and September 2017. Sanger sequencing was performed to determine the proportion of M. genitalium infections with SNPs in parC that have previously been associated with failure of moxifloxacin (corresponding to amino changes S83I, D83R, D87Y and D87N) and in gyrA (corresponding to amino acid changes M95I, D99N, D99Y and D99G). Associations between clinical/behavioural factors and parC SNPs were examined. Strain typing was performed by sequencing a portion of the mgpB gene.Results. The proportion of MSM with infections harbouring parC and gyrA SNPs was 13.0 % [95 % confidence interval (CI): 6.8-23.2 %] and 4.7 % (95 % CI: 1.1-13.4 %), respectively; dual-class resistance was 13.0 %. No significant clinical/behavioural associations were found. Antibiotic resistance was not restricted to specific mgpB STs.Conclusion. One in eight (13 %) of asymptomatic MSM with M. genitalium had an infection with dual-class-resistance mutations. Typing by mgpB sequence suggested fluoroquinolone resistance is arising from independent mutation events. This study illustrates that asymptomatic MSM may act as a reservoir for antibiotic-resistant M. genitalium.
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Affiliation(s)
- Teck-Phui Chua
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Kaveesha Bodiyabadu
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Dorothy A Machalek
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,Kirby Institute, University of New South Wales, Kensington, Sydney, New South Wales, Australia
| | - Suzanne M Garland
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Erica L Plummer
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Danielewski
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michelle L Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Gerald L Murray
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia
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Parmar NR, Mushanski L, Wanlin T, Lepe A, Lang A, Minion J, Dillon JAR. High Prevalence of Macrolide and Fluoroquinolone Resistance-Mediating Mutations in Mycoplasma genitalium-Positive Urine Specimens From Saskatchewan. Sex Transm Dis 2021; 48:680-684. [PMID: 34397971 DOI: 10.1097/olq.0000000000001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mycoplasma genitalium is an emerging, sexually transmitted infection, which is more prevalent than Chlamydia trachomatis in some regions. An increase in antibiotic resistance, that is, azithromycin and moxifloxacin, recommended for treating M. genitalium infections has been noted. This is the first detailed report on the prevalence of M. genitalium and its antimicrobial resistance in Saskatchewan, Canada. METHODS Aptima urine specimens (n = 1977), collected for the diagnosis of C. trachomatis/Neisseria gonorrhoeae, were tested for M. genitalium using the Aptima M. genitalium assay (MG-TMA). Antimicrobial resistance was ascertained using polymerase chain reaction and DNA sequencing of 23S rRNA (azithromycin) and parC (moxifloxacin) from Aptima M. genitalium assay-positive specimens; mutations predictive of resistance were noted. RESULTS The prevalence of M. genitalium was 9.6% (189/1977). Predicted resistance to azithromycin (substitutions at positions 2058/2059 in 23S rRNA) was observed in 63.6% (70/110) of the specimens tested, whereas resistance to moxifloxacin (S83I in ParC) was observed in 10.6% (9/85) of the specimens. Mutations in both 23S rRNA and ParC were observed in 2.12% (4/189) of the specimens. Women aged 20 to 24 years had the highest prevalence (18.3%, P < 0.001), and in females, M. genitalium was significantly associated with C. trachomatis or N. gonorrhoeae/C. trachomatis (P < 0.001) coinfection. The prevalence of M. genitalium (9.6%) in the province of Saskatchewan was higher than that of the other 2 bacterial sexually transmitted infections (N. gonorrhoeae (3.09%) and C. trachomatis (6.85%). CONCLUSIONS The prevalence of M. genitalium (9.6%) and associated resistance to azithromycin (63.6%) in Saskatchewan high, suggesting that empiric azithromycin therapy may not be adequate for treating M. genitalium infections.
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Affiliation(s)
| | - Linda Mushanski
- Saskatchewan Health Authority, Roy Romanow Provincial Laboratory, Regina, Saskatchewan, Canada
| | - Tasker Wanlin
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon
| | | | - Amanda Lang
- Saskatchewan Health Authority, Roy Romanow Provincial Laboratory, Regina, Saskatchewan, Canada
| | - Jessica Minion
- Saskatchewan Health Authority, Roy Romanow Provincial Laboratory, Regina, Saskatchewan, Canada
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 767] [Impact Index Per Article: 255.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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20
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Shedko ED, Goloveshkina EN, Akimkin VG. Molecular epidemiology and antimicrobials resistance mechanism of Mycoplasma genitlaium. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Currently, infections caused by Mycoplasma genitalium are ones the most common sexually transmitted infections. Their prevalence is varied from 1.3% to 15.9%. Infections caused by M.genitalium may lead to urethritis in men and a wide spectrum of diseases in women. Antibiotic resistance now is one of the most emerging problems both in the scientific and in the healthcare fields. The usage of antimicrobials inhibiting cell wall synthesis for the treatment of M.genitalium is ineffective, and resistance to macrolides and fluoroquinolones is increasing rapidly. M.genitalium infections diagnostics is complicated due to specific conditions and duration of culture methods. The usage of nucleic acid amplification techniques is the most relevant for laboratory diagnostics, and is used in existing assays. This review compiles current data on the prevalence, molecular mechanisms of pathogenesis and antibiotic resistance, as well as diagnostics methods of M.genitalium.
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21
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Stafford IA, Hummel K, Dunn JJ, Muldrew K, Berra A, Kravitz ES, Gogia S, Martin I, Munson E. Retrospective analysis of infection and antimicrobial resistance patterns of Mycoplasma genitalium among pregnant women in the southwestern USA. BMJ Open 2021; 11:e050475. [PMID: 34127494 PMCID: PMC8204150 DOI: 10.1136/bmjopen-2021-050475] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium is a sexually transmitted infection (STI) pathogen. There have been no published studies concerning symptomatology, prevalence data, antibiotic resistance profiling or reports of co-infection with other STI in pregnant women. OBJECTIVE To describe these characteristics among pregnant women attending prenatal clinics in a large tertiary care centre. DESIGN Remnant genital samples collected from pregnant women between August 2018 and November 2019 were tested for M. genitalium and Trichomonas vaginalis by the transcription-mediated amplification technique. Specimens with detectable M. genitalium RNA were sequenced for 23S rRNA mutations associated with azithromycin resistance and parC and gyrA mutations associated with resistance to moxifloxacin. Demographic, obstetric and STI co-infection data were recorded. RESULTS Of the 719 samples, 41 (5.7 %) were positive for M. genitalium. M. genitalium infection was associated with black race, Hispanic ethnicity and young age (p=0.003, p=0.008 and p=0.004, respectively). M. genitalium infection was also associated with T. vaginalis co-infection and Streptococcus agalactiae (group B Streptococcus) colonisation (p≤0.001 and p=0.002, respectively). Of the 41 positive samples, 26 (63.4%) underwent successful sequencing. Eight (30.8%) had 23S rRNA mutations related to azithromycin resistance. One of 26 (3.8%) positive samples with sequencing results had the gyrA gene mutation and 1 of 18 sequenced samples (5.6%) had the parC gene mutation associated with moxifloxacin resistance. CONCLUSIONS Prevalence rates of M. genitalium in pregnant women was 5.7%. M. genitalium infection disproportionately affects young black women co-infected with T. vaginalis. Pregnant women remain at risk for persistent infection with M. genitalium due to decreased azithromycin susceptibility.
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Affiliation(s)
- Irene A Stafford
- Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kelsey Hummel
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - James J Dunn
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Kenneth Muldrew
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Alexandra Berra
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Irene Martin
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Erik Munson
- Clinical Laboratory Science, Marquette University, Milwaukee, Wisconsin, USA
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22
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Durukan D, Read TRH, Murray G, Doyle M, Chow EPF, Vodstrcil LA, Fairley CK, Aguirre I, Mokany E, Tan LY, Chen MY, Bradshaw CS. Resistance-Guided Antimicrobial Therapy Using Doxycycline-Moxifloxacin and Doxycycline-2.5 g Azithromycin for the Treatment of Mycoplasma genitalium Infection: Efficacy and Tolerability. Clin Infect Dis 2021; 71:1461-1468. [PMID: 31629365 DOI: 10.1093/cid/ciz1031] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/15/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Macrolide resistance in Mycoplasma genitalium (MG) exceeds 50% in many regions, and quinolone resistance is increasing. We recently reported that resistance-guided therapy (RGT) using doxycycline followed by sitafloxacin or 2.5 g azithromycin cured 92% and 95% of macrolide-resistant and macrolide-susceptible infections, respectively. We present data on RGT using doxycycline-moxifloxacin, the regimen recommended in international guidelines, and extend data on the efficacy of doxycycline-2.5 g azithromycin and de novo macrolide resistance. METHODS Patients attending Melbourne Sexual Health Centre between 2017 and 2018 with sexually transmitted infection syndromes were treated with doxycycline for 7 days and recalled if MG-positive. Macrolide-susceptible cases received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and resistant cases moxifloxacin (400 mg daily, 7 days). Test of cure was recommended 14-28 days post-antimicrobials. RESULTS There were 383 patients (81 females/106 heterosexual males/196 men who have sex with men) included. Microbial cure following doxycycline-azithromycin was 95.4% (95% confidence interval [CI], 89.7-98.0) and doxycycline-moxifloxacin was 92.0% (95% CI, 88.1-94.6). De novo macrolide resistance was detected in 4.6% of cases. Combining doxycycline-azithromycin data with our prior RGT study (n = 186) yielded a pooled cure of 95.7% (95% CI, 91.6-97.8). ParC mutations were present in 22% of macrolide-resistant cases. CONCLUSIONS These findings support the inclusion of moxifloxacin in resistance-guided strategies and extend the evidence for 2.5 g azithromycin and presumptive use of doxycycline. These data provide an evidence base for current UK, Australian, and European guidelines for the treatment of MG.
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Affiliation(s)
- Duygu Durukan
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Tim R H Read
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Gerald Murray
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Eric P F Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Lenka A Vodstrcil
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Ivette Aguirre
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Elisa Mokany
- SpeeDx Pty Ltd, National Innovation Centre, Eveleigh, New South Wales, Australia
| | - Lit Y Tan
- SpeeDx Pty Ltd, National Innovation Centre, Eveleigh, New South Wales, Australia
| | - Marcus Y Chen
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Catriona S Bradshaw
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
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23
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Vesty A, McAuliffe G, Roberts S, Henderson G, Basu I. Mycoplasma genitalium Antimicrobial Resistance in Community and Sexual Health Clinic Patients, Auckland, New Zealand. Emerg Infect Dis 2021; 26:332-335. [PMID: 31961302 PMCID: PMC6986824 DOI: 10.3201/eid2602.190533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Our retrospective study compared genotypic antimicrobial resistance in Mycoplasma genitalium-positive specimens collected from 48 community and 33 sexual health clinic (SHC) patients. Macrolide resistance was similar in community (75%) and SHC (76%) patients. We observed no significant difference in fluoroquinolone resistance between community (19%) and SHC (27%) patients (p = 0.66).
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24
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Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at a STI Clinic in Guangzhou, China, 2016-2018. BMC Infect Dis 2020; 20:950. [PMID: 33308173 PMCID: PMC7731746 DOI: 10.1186/s12879-020-05659-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Antimicrobial resistance in M. genitalium is a growing clinical problem. We investigated the mutations associated with macrolide and fluoroquinolone resistance, two commonly used medical regimens for treatment in China. Our aim is to analyze the prevalence and diversity of mutations among M. genitalium-positive clinical specimens in Guangzhou, south China. Methods A total of 154 stored M. genitalium positive specimens from men and women attending a STI clinic were tested for macrolide and fluoroquinolone mutations. M. genitalium was detected via TaqMan MGB real-time PCR. Mutations associated with macrolide resistance were detected using primers targeting region V of the 23S rRNA gene. Fluoroquinolone resistant mutations were screened via primers targeting topoisomerase IV (parC) and DNA gyrase (gyrA). Results 98.7% (152/154), 95.5% (147/154) and 90.3% (139/154) of M. genitalium positive samples produced sufficient amplicon for detecting resistance mutations in 23S rRNA, gyrA and parC genes, respectively. 66.4% (101/152), 0.7% (1/147) and 77.7% (108/139) samples manifested mutations in 23S rRNA, gyrA and parC genes, respectively. A2072G (59/101, 58.4%) and S83I (79/108, 73.1%) were highly predominating in 23S rRNA and parC genes, respectively. Two samples had amino acid substitutions in gyrA (M95I and A96T, respectively). Two samples had two amino acid substitutions in parC (S83I + D87Y). 48.6% (67/138) of samples harbored both macrolide and fluoroquinolone resistance-associated mutations. The most common combination of mutations was A2072G (23S rRNA) and S83I (parC) (40/67, 59.7%). One sample had three amino acid changes in 23S rRNA, gyrA and parC genes (A2072G + A96T + S83I). Conclusions The high antimicrobial resistance rate of M. genitalium in Guangzhou is a very worrying problem and suggests that antimicrobial resistance testing and the development of new antibiotic regimens are crucially needed.
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25
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Han T, Zhang Q, Liu N, Wang J, Li Y, Huang X, Liu J, Wang J, Qu Z, Qi K. Changes in antibiotic resistance of Escherichia coli during the broiler feeding cycle. Poult Sci 2020; 99:6983-6989. [PMID: 33248614 PMCID: PMC7704736 DOI: 10.1016/j.psj.2020.06.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to investigate the drug-resistant phenotypes and genes of Escherichia coli in animal, environmental, and human samples before and after antibiotic use at a large-scale broiler farm to understand the respective effects on E. coli resistance during the broiler feeding cycle. The antibiotic use per broiler house was 143.04 to 183.50 mg/kg, and included tilmicosin, florfenicol, apramycin, and neomycin. All strains isolated on the first day the broilers arrived (T1; day 1) were antibiotic-resistant bacteria. E. coli strains isolated from animal samples were resistant to ampicillin, tetracycline, and sulfamethoxazole (100%), and those isolated from environmental samples were resistant to 5 different drugs (74.07%, 20 of 27). E. coli strains isolated on the last day before the broilers left (T2; day 47) had a higher resistance rate to florfenicol (100%, 36 of 36) than at T1 (P < 0.05). Multidrug resistance increased from T1 (84.21%, 32 of 38) to T2 (97.22%, 35 of 36). Most strains were resistant to 5 classes of antibiotics, and 2 strains were resistant to 6 classes of antibiotics. Among 13 identified drug resistance genes, 11 and 13 were detected at T1 and T2, respectively. NDM-1 was detected in 4 environmental samples and 1 animal sample. In conclusion, the use of antibiotics during breeding increases E. coli resistance to antibacterial drugs. Drug-resistant bacteria in animals and the environment proliferate during the feeding cycle, leading to the widespread distribution of drug resistance genes and an increase in the overall resistance of bacteria.
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Affiliation(s)
- Tianfei Han
- Anhui Province Key Laboratory of Veterinary Pathobiology and Disease Control, College of Animal Science and Technology, Anhui Agricultural University, Hefei, Anhui, China; Livestock and Poultry Products Quality & Safety Risk Assessment Laboratory (Qingdao) of Ministry of Agriculture and Rural Affairs, China Animal Health and Epidemiology Center, Qingdao, Shandong, China.
| | - Qingqing Zhang
- Livestock and Poultry Products Quality & Safety Risk Assessment Laboratory (Qingdao) of Ministry of Agriculture and Rural Affairs, China Animal Health and Epidemiology Center, Qingdao, Shandong, China
| | - Na Liu
- Livestock and Poultry Products Quality & Safety Risk Assessment Laboratory (Qingdao) of Ministry of Agriculture and Rural Affairs, China Animal Health and Epidemiology Center, Qingdao, Shandong, China
| | - Juan Wang
- Livestock and Poultry Products Quality & Safety Risk Assessment Laboratory (Qingdao) of Ministry of Agriculture and Rural Affairs, China Animal Health and Epidemiology Center, Qingdao, Shandong, China
| | - Yuehua Li
- Livestock and Poultry Products Quality & Safety Risk Assessment Laboratory (Qingdao) of Ministry of Agriculture and Rural Affairs, China Animal Health and Epidemiology Center, Qingdao, Shandong, China
| | - Xiumei Huang
- Livestock and Poultry Products Quality & Safety Risk Assessment Laboratory (Qingdao) of Ministry of Agriculture and Rural Affairs, China Animal Health and Epidemiology Center, Qingdao, Shandong, China
| | - Junhui Liu
- Livestock and Poultry Products Quality & Safety Risk Assessment Laboratory (Qingdao) of Ministry of Agriculture and Rural Affairs, China Animal Health and Epidemiology Center, Qingdao, Shandong, China
| | - Junwei Wang
- Livestock and Poultry Products Quality & Safety Risk Assessment Laboratory (Qingdao) of Ministry of Agriculture and Rural Affairs, China Animal Health and Epidemiology Center, Qingdao, Shandong, China
| | - Zhina Qu
- Livestock and Poultry Products Quality & Safety Risk Assessment Laboratory (Qingdao) of Ministry of Agriculture and Rural Affairs, China Animal Health and Epidemiology Center, Qingdao, Shandong, China.
| | - Kezong Qi
- Anhui Province Key Laboratory of Veterinary Pathobiology and Disease Control, College of Animal Science and Technology, Anhui Agricultural University, Hefei, Anhui, China
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26
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Pitt R, Fifer H, Woodford N, Hopkins S, Cole MJ. Prevalence of Chlamydia trachomatis and Mycoplasma genitalium coinfections and M. genitalium antimicrobial resistance in rectal specimens. Sex Transm Infect 2020; 97:469-470. [PMID: 33106438 DOI: 10.1136/sextrans-2020-054803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 09/30/2020] [Accepted: 10/11/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Rachel Pitt
- National Infection Service, Public Health England, London, UK
| | - Helen Fifer
- National Infection Service, Public Health England, London, UK
| | - Neil Woodford
- National Infection Service, Public Health England, London, UK
| | - Susan Hopkins
- National Infection Service, Public Health England, London, UK
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27
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Plummer EL, Murray GL, Bodiyabadu K, Su J, Garland SM, Bradshaw CS, Read TRH, Tabrizi SN, Danielewski JA. A custom amplicon sequencing approach to detect resistance associated mutations and sequence types in Mycoplasma genitalium. J Microbiol Methods 2020; 179:106089. [PMID: 33184030 DOI: 10.1016/j.mimet.2020.106089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/24/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Mycoplasma genitalium resistance to antibiotic treatments is increasing, with very limited treatment alternatives on the horizon. Surveillance via sequencing of multiple M. genitalium loci would allow: monitoring of known antibiotic resistance mutations, associations between resistance/treatment failure and specific mutations, and strain typing for epidemiological purposes. In this study we assessed the performance of a custom amplicon sequencing approach, which negates the cost of library preparation for next generation sequencing. METHODS Fifty-two M. genitalium positive samples (cervical, vaginal, anal and rectal swabs, and urine) were used. Three regions associated with M. genitalium antibiotic resistance (23S rRNA, parC and gyrA genes) were targeted, in conjunction with a locus used for differentiation of sequence types in the mgpB gene, and findings compared to Sanger sequencing. RESULTS Amplicon sequencing provided adequate sequence read coverage (>30×) for the majority of samples for 23S rRNA gene (96%) and mgpB (97%), parC (78%) and gyrA (75%). Single nucleotide polymorphisms (SNPs) were characterised in samples for 23S rRNA gene (94%), parC (56%) and gyrA (4%). Unlike Sanger sequencing, mixed mutations could be identified by the amplicon sequencing method, and ratios of mutation types determined. All results, with one exception, were concordant to Sanger sequence results. Sequence diversity in the mgpB region was represented by 15 sequence types, 4 being observed in multiple samples. CONCLUSIONS We have demonstrated the utility of this custom amplicon sequencing approach for generating highly informative datasets with the capacity to identify and determine ratios of mixed sequences. The use of this customisable amplicon sequencing method enables cost effective, scalable amplicon sequencing of multiple target regions of interest in M. genitalium.
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Affiliation(s)
- E L Plummer
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - G L Murray
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - K Bodiyabadu
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - J Su
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - S M Garland
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - C S Bradshaw
- Melbourne Sexual Health Centre, Alfred Hospital, Carlton, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - T R H Read
- Melbourne Sexual Health Centre, Alfred Hospital, Carlton, Victoria, Australia
| | - S N Tabrizi
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - J A Danielewski
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
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28
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Ong JJ, Magooa MP, Chikandiwa A, Kelly H, Didelot MN, Muller EE, Maseko V, Segondy M, Delany-Moretlwe S, Kularatne R, Mayaud P. Prevalence and Antimicrobial Resistance of Mycoplasma genitalium Infection Among Women Living With Human Immunodeficiency Virus in South Africa: A Prospective Cohort Study. Clin Infect Dis 2020; 69:873-876. [PMID: 30698679 DOI: 10.1093/cid/ciz045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/14/2019] [Indexed: 11/12/2022] Open
Abstract
This prospective cohort study of 622 women living with human immunodeficiency virus (HIV) from Johannesburg (2012) detected Mycoplasma genitalium in 7.4% (95% confidence interval [CI]: 5.5-9.7, 46/622), with detection more likely with lower CD4 counts(adjusted odds ratio [AOR] 1.02 per 10 cells/μL decrease, 95% CI: 1.00-1.03) and higher plasma HIV-1 RNA (AOR 1.15 per log copies/mL increase, 95% CI: 1.03-1.27). No mutations for macrolide/quinolone resistance was detected.
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Affiliation(s)
- Jason J Ong
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom.,Central Clinical School, Monash University, Australia
| | | | - Admire Chikandiwa
- Wits Reproductive Health & HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Helen Kelly
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Marie-Noelle Didelot
- Pathogenesis and Control of Chronic infections, INSERM, University of Montpellier, France
| | - Etienne E Muller
- Centre for HIV & STIs, National Institute for Communicable Diseases
| | - Venessa Maseko
- Centre for HIV & STIs, National Institute for Communicable Diseases
| | - Michel Segondy
- Pathogenesis and Control of Chronic infections, INSERM, University of Montpellier, France
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health & HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | | | - Philippe Mayaud
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom
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29
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De Baetselier I, Kenyon C, Vanden Berghe W, Smet H, Wouters K, Van den Bossche D, Vuylsteke B, Crucitti T. An alarming high prevalence of resistance-associated mutations to macrolides and fluoroquinolones in Mycoplasma genitalium in Belgium: results from samples collected between 2015 and 2018. Sex Transm Infect 2020; 97:297-303. [PMID: 32769204 DOI: 10.1136/sextrans-2020-054511] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The number of reported cases of multiresistant Mycoplasma genitalium (MG) is increasing globally. The aim of this study was to estimate the prevalence of macrolide and possible fluoroquinolone resistance-associated mutations (RAMs) of MG in Belgium. METHODS The study was performed retrospectively on two sets of MG-positive samples collected in Belgium between 2015 and 2018. The first set of samples originated from routine surveillance activities and the second set came from a cohort of men who have sex with men (MSM) using pre-exposure prophylaxis to prevent HIV transmission. Detection of RAMs to macrolides and fluoroquinolones was performed on all samples using DNA sequencing of the 23S ribosomal RNA gene, the gyrA gene and the parC gene. RESULTS Seventy-one per cent of the MG samples contained a mutation conferring resistance to macrolides or fluoroquinolones (ParC position 83/87). RAMs were more frequently found among men compared with women for fluoroquinolones (23.9% vs 9.1%) and macrolides (78.4% vs 27.3%). Almost 90% of the MG infections among MSM possessed a RAM to macrolides (88.4%). In addition, 18.0% of the samples harboured both macrolides and fluoroquinolone RAMs; 3.0% in women and 24.2% in MSM. Being MSM was associated with macrolide RAMs (OR 15.3), fluoroquinolone RAMs (OR 3.8) and having a possible multiresistant MG infection (OR 7.2). CONCLUSION The study shows an alarmingly high prevalence of MG with RAMs to macrolides and fluoroquinolones in Belgium. These results highlight the need to improve antimicrobial stewardship in Belgium in order to avoid the emergence of untreatable MG.
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Affiliation(s)
- Irith De Baetselier
- Department of Clinical Sciences, STI Reference Laboratory, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Hilde Smet
- Department of Clinical Sciences, STI Reference Laboratory, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Kristien Wouters
- Department of Clinical Sciences, STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dorien Van den Bossche
- Department of Clinical Sciences, STI Reference Laboratory, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bea Vuylsteke
- Public Health, HIV/STI Unit, Institute of Tropical Medicine, Antwerpen, Belgium
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Machalek DA, Tao Y, Shilling H, Jensen JS, Unemo M, Murray G, Chow EPF, Low N, Garland SM, Vodstrcil LA, Fairley CK, Hocking JS, Zhang L, Bradshaw CS. Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2020; 20:1302-1314. [PMID: 32622378 DOI: 10.1016/s1473-3099(20)30154-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 01/17/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mycoplasma genitalium is now recognised as an important bacterial sexually transmitted infection. We summarised data from studies of mutations associated with macrolide and fluoroquinolone resistance in M genitalium to establish the prevalence of resistance. We also investigated temporal trends in resistance and aimed to establish the association between resistance and geographical location. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, and MEDLINE for studies that included data for the prevalence of mutations associated with macrolide and fluoroquinolone resistance in M genitalium published in any language up to Jan 7, 2019. We defined prevalence as the proportion of M genitalium samples positive for key mutations associated with azithromycin resistance (23S rRNA gene, position 2058 or 2059) or moxifloxacin resistance (S83R, S83I, D87N, or D87Y in parC), or both, among all M genitalium samples that were successfully characterised. We used random-effects meta-analyses to calculate summary estimates of prevalence. Subgroup and meta-regression analyses by WHO region and time period were done. This study was registered with PROSPERO, number CRD42016050370. RESULTS Overall, 59 studies from 21 countries met the inclusion criteria for our study: 57 studies of macrolide resistance (8966 samples), 25 of fluoroquinolone resistance (4003 samples), and 22 of dual resistance to macrolides and fluoroquinolones (3280 samples). The summary prevalence of mutations associated with macrolide resistance among M genitalium samples was 35·5% (95% CI 28·8-42·5); prevalence increased from 10·0% (95% CI 2·6-20·1%) before 2010, to 51·4% (40·3-62·4%) in 2016-17 (p<0·0001). Prevalence of mutations associated with macrolide resistance was significantly greater in samples in the WHO Western Pacific and Americas regions than in those from the WHO European region. The overall prevalence of mutations associated with fluoroquinolone resistance in M genitalium samples was 7·7% (95% CI 4·5-11·4%). Prevalence did not change significantly over time, but was significantly higher in the Western Pacific region than in the European region. Overall, the prevalence of both mutations associated with macrolide resistance and those associated with fluoroquinolone resistance among M genitalium samples was 2·8% (1·3-4·7%). The prevalence of dual resistance did not change significantly over time, and did not vary significantly by geographical region. INTERPRETATION Global surveillance and measures to optimise the efficacy of treatments-including resistance-guided strategies, new antimicrobials, and antimicrobial combination approaches-are urgently needed to ensure cure in a high proportion of M genitalium infections and to prevent further spread of resistant strains. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Dorothy A Machalek
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; The Kirby Institute, University of New South Wales, Kensington, Sydney, NSW, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
| | - Yusha Tao
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hannah Shilling
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jørgen S Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gerald Murray
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Catriona S Bradshaw
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
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Mycoplasma genitalium, Chlamydia trachomatis, and Neisseria gonorrhoeae Detected With Aptima Assays Performed on Self-Obtained Vaginal Swabs and Urine Collected at Home and in a Clinic. Sex Transm Dis 2020; 46:e87-e89. [PMID: 31415336 DOI: 10.1097/olq.0000000000001004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Self-obtained vaginal swabs, first-void urine and pooled specimens were collected at home and in a clinic. Percent prevalence and collection site concordance was 30.3 and 100 for Mycoplasma genitalium (74.4% azithromycin resistant) 15.1 and 96.7 for Chlamydia trachomatis and 6.6 and 100 for Neisseria gonorrhoeae (27% ciprofloxacin-resistant).
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Laumen JGE, van Alphen LB, Maduna LD, Hoffman CM, Klausner JD, Medina-Marino A, Kock MM, Peters RPH. Molecular epidemiological analysis of Mycoplasma genitalium shows low prevalence of azithromycin resistance and a well-established epidemic in South Africa. Sex Transm Infect 2020; 97:152-156. [PMID: 32389900 DOI: 10.1136/sextrans-2019-054371] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/16/2020] [Accepted: 04/18/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Macrolide resistance in Mycoplasma genitalium is emerging globally. There is paucity of data from sub-Saharan Africa where syndromic management is used to treat sexually transmitted infections (STIs). We conducted a molecular epidemiological study to determine the prevalence of azithromycin resistance and epidemic diversity of M. genitalium infections in South Africa. METHODS We analysed 90 M. genitalium-positive specimens that had been collected consecutively from men and women (50% symptomatic) from geographically diverse communities across the northern part of South Africa between 2015 and 2019. Melting curve analysis followed by targeted sequencing of the 23S rRNA gene was performed to detect azithromycin resistance. Molecular typing was done through single nucleotide polymorphism (SNP) analysis of the MG191 gene and short tandem repeats (STR) assessment of the MG309 gene. An overview of all published M. genitalium sequence types was generated and novel sequence types identified in this study were allocated numbers accordingly. RESULTS Azithromycin resistance was detected in 1/90 M. genitalium-positive specimens (1.1%; 95% CI 0% to 3.3%) as conferred by A2071G mutation; this strain also harboured a C234T mutation in the parC gene with wild type gyrA gene. SNP typing and STR assessment was successful in 38/90 specimens (42%) and showed a genetically diverse epidemic, without geographic clustering, with eight novel sequence types identified. CONCLUSION This is the first study that determines resistance in M. genitalium infection since introduction of azithromycin in the syndromic management regimen for STIs in South Africa in 2015. Despite a well-established epidemic, azithromycin-resistant M. genitalium infection is still uncommon in the public healthcare sector. However, it has the potential to undermine the effectiveness of syndromic management. Introduction of molecular diagnostics and continuous surveillance are warranted for early detection emergence of resistance.
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Affiliation(s)
- Jolein G E Laumen
- Department of Medical Microbiology, CAPHRI School for Public Health & Primary Care, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands.,Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Lieke B van Alphen
- Department of Medical Microbiology, CAPHRI School for Public Health & Primary Care, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands
| | - Liteboho D Maduna
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Charlotte M Hoffman
- Department of Medical Microbiology, CAPHRI School for Public Health & Primary Care, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands
| | - Jeffrey D Klausner
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Andrew Medina-Marino
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.,Research Unit, Foundation for Professional Development, East London, South Africa
| | - Marleen M Kock
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Tswhane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Remco P H Peters
- Department of Medical Microbiology, CAPHRI School for Public Health & Primary Care, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands .,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Research Unit, Foundation for Professional Development, East London, South Africa
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Hart T, Tang WY, Mansoor SAB, Chio MTW, Barkham T. Mycoplasma genitalium in Singapore is associated with Chlamydia trachomatis infection and displays high macrolide and Fluoroquinolone resistance rates. BMC Infect Dis 2020; 20:314. [PMID: 32345231 PMCID: PMC7189604 DOI: 10.1186/s12879-020-05019-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/07/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Mycoplasma genitalium is an emerging sexually transmitted infection, with increasing rates of resistance to fluroquinolones and macrolides, the recommended treatments. Despite this, M. genitalium is not part of routine screening for Sexually Transmitted Infections (STIs) in many countries and the prevalence of infection and patterns of disease remain to be determined in many populations. Such data is of particular importance in light of the reported rise in antibiotic resistance in M. genitalium isolates. METHODS Urine and urethral swab samples were collected from the primary public sexual health clinic in Singapore and tested for C. trachomatis (CT) or N. gonorrhoeae (NG) infection and for the presence of M. genitalium. Antibiotic resistance in M. genitalium strains detected was determined by screening for genomic mutations associated with macrolide and fluroquinolone resistance. RESULTS We report the results of a study into M. genitalium prevalence at the national sexual health clinic in Singapore. M. genitalium was heavily associated with CT infection (8.1% of cases), but present in only of 2.4% in CT negative cases and not independently linked to NG infection. Furthermore, we found high rates of resistance mutations to both macrolides (25%) and fluoroquinolones (37.5%) with a majority of resistant strains being dual-resistant. Resistance mutations were only found in strains from patients with CT co-infection. CONCLUSIONS Our results support targeted screening of CT positive patients for M. genitalium as a cost-effective strategy to reduce the incidence of M. genitalium in the absence of comprehensive routine screening. The high rate of dual resistance also highlights the need to ensure the availability of alternative antibiotics for the treatment of multi-drug resistant M. genitalium isolates.
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MESH Headings
- Ambulatory Care Facilities
- Anti-Bacterial Agents/pharmacology
- Anti-Bacterial Agents/therapeutic use
- Chlamydia Infections/complications
- Chlamydia Infections/diagnosis
- Chlamydia Infections/drug therapy
- Chlamydia trachomatis/drug effects
- Chlamydia trachomatis/genetics
- Chlamydia trachomatis/isolation & purification
- DNA, Bacterial/genetics
- DNA, Bacterial/metabolism
- Drug Resistance, Multiple, Bacterial/genetics
- Fluoroquinolones/pharmacology
- Fluoroquinolones/therapeutic use
- Humans
- Macrolides/pharmacology
- Macrolides/therapeutic use
- Mycoplasma Infections/complications
- Mycoplasma Infections/diagnosis
- Mycoplasma Infections/drug therapy
- Mycoplasma Infections/epidemiology
- Mycoplasma genitalium/drug effects
- Mycoplasma genitalium/genetics
- Mycoplasma genitalium/isolation & purification
- Prevalence
- RNA, Ribosomal, 23S/chemistry
- RNA, Ribosomal, 23S/genetics
- RNA, Ribosomal, 23S/metabolism
- Sequence Analysis, DNA
- Singapore/epidemiology
- Urethra/microbiology
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Affiliation(s)
- Tim Hart
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Wen Ying Tang
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Siti Aminah Bte Mansoor
- Department of Sexually Transmitted Infections Control Clinic, 31 Kelantan Ln, Singapore, 200031, Singapore
| | - Martin T W Chio
- Department of Sexually Transmitted Infections Control Clinic, 31 Kelantan Ln, Singapore, 200031, Singapore
| | - Timothy Barkham
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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Mycoplasma genitalium Infections With Macrolide and Fluoroquinolone Resistance-Associated Mutations in Heterosexual African American Couples in Alabama. Sex Transm Dis 2020; 46:18-24. [PMID: 29979336 DOI: 10.1097/olq.0000000000000891] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mycoplasma genitalium (MG) is a sexually transmitted pathogen associated with inflammatory syndromes in men and women. Macrolides and fluoroquinolones are recommended MG treatments. The frequency of MG strains with macrolide resistance-associated mutations (MRMs) and quinolone resistance-associated mutations (qRMs) is increasing worldwide, however these data are sparse in populations in the United States. METHODS We investigated the prevalence of MG infections with MRMs and qRMs and MG infection concordance within African American couples in Birmingham, AL. We used a real-time polymerase chain reaction to detect MG and identify MRMs. quinolone resistance-associated mutations were detected using traditional polymerase chain reactions amplifying regions in gyrA, gyrB, parC, and parE. The MG concordance in couples was evaluated by MG positivity and MG genotypes. RESULTS Oral, anal, urine, and/or vaginal specimens were tested from 116 couples. Twenty-eight (12.1%) participants comprising 22 couples tested MG-positive (11.2% in men and 12.9% in women). Macrolide resistance-associated mutations were detected in 17 (60.7%) MG-positive participants, with gender-specific resistance rates of 69.2% for men and 53.3% for women. quinolone resistance-associated mutations were detected in 3 (11.1%) MG-positive participants, all of whom also had MRMs. By MG positivity status, 27.3% of couples were concordant. If MG strain genotypes are also considered, then concordance was 20.0%. CONCLUSIONS Among heterosexual African Americans with MG infection, about 60% had strains with MRMs and 11% had strains with both MRMs and qRMs, highlighting the potential for MG treatment failure to not only macrolides, but also quinolones. These findings may help to guide clinicians in MG testing and treatment decisions in the United States.
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Li Y, Su X, Le W, Li S, Yang Z, Chaisson C, Madico G, Gong X, Reed GW, Wang B, Rice PA. Mycoplasma genitalium in Symptomatic Male Urethritis: Macrolide Use Is Associated With Increased Resistance. Clin Infect Dis 2020; 70:805-810. [PMID: 30972419 PMCID: PMC7390511 DOI: 10.1093/cid/ciz294] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/04/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium (MG) causes symptomatic urethritis in men, and can infect alone or together with other sexually transmitted infection (STI) agents. METHODS The prevalence of MG and other STIs was determined in 1816 men with symptomatic urethritis. Resistance of MG to macrolides and fluoroquinolones was determined by sequencing; the impact of recent antimicrobial usage on the distribution of MG single or mixed infections was determined. RESULTS Overall, prevalence of MG infection was 19.7% (358/1816). Fifty-four percent (166/307) of MG infections occurred alone in the absence of other STI agents. Men with single MG infection self-administered or were prescribed antibiotics more often in the 30 days prior to enrollment than subjects with urethritis caused by MG coinfection (P < .0001). Higher rates (96.7%) of infection with macrolide resistance in MG were identified in men who had taken macrolides prior to enrollment (P < .03). Overall, 88.9% (303/341) of 23S ribosomal RNA (rRNA) genes contained mutations responsible for macrolide resistance; 89.5% (308/344) of parC and 12.4% (42/339) of gyrA genes had mutations responsible for fluoroquinolone resistance. Approximately 88% (270/308) of MG had combined mutations in 23S rRNA and parC genes; 10.4% (32/308) had mutations in all 3 genes. CONCLUSIONS MG was the single pathogen identified in 11% of men with symptomatic urethritis. Overall, nearly 90% of MG infections were resistant to macrolides and fluoroquinolones. Men who took macrolides in the 30 days prior to enrollment had higher rates (97%) of macrolide-resistant MG. Resistance was associated with numerous mutations in 23SrRNA, parC, and gyrA genes.
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Affiliation(s)
- Yang Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
- Affiliated Qingdao Municipal Hospital of Qingdao University, China
| | - Xiaohong Su
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Wenjing Le
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Sai Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Zhaoyan Yang
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health
| | - Christine Chaisson
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health
| | - Guillermo Madico
- National Emerging Infectious Diseases Laboratories, Boston University
| | - Xiangdong Gong
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - George W Reed
- Department of Medicine, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester
- Corrona Research Foundation, Albany, New York
| | - Baoxi Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peter A Rice
- Department of Medicine, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester
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van der Schalk TE, Braam JF, Kusters JG. Molecular basis of antimicrobial resistance in Mycoplasma genitalium. Int J Antimicrob Agents 2020; 55:105911. [PMID: 31991219 DOI: 10.1016/j.ijantimicag.2020.105911] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 01/03/2020] [Accepted: 01/18/2020] [Indexed: 11/29/2022]
Abstract
Mycoplasma genitalium is a sexually transmitted urogenital pathogen, and infection can result in serious symptoms. As M. genitalium is rather difficult to culture, infections are usually detected by molecular methods. Unfortunately, there has recently been a significant increase in resistance to azithromycin and moxifloxacin used for the treatment of M. genitalium infections. The increased resistance to (often empirically prescribed) M. genitalium treatments has resulted in frequent therapy failures and stresses the need for routine detection of antimicrobial resistance. In M. genitalium, antimicrobial resistance is almost always the result of DNA mutations and thus can easily be detected by molecular techniques. Regrettably, many microbiology laboratories do not use molecular techniques for the detection of bacterial antimicrobial resistance. As molecular tests are becoming available for M. genitalium, both for the establishment of infection and the detection of antimicrobial resistance, it is now more important to ensure that knowledge on the resistance mechanisms is transferred from the laboratory to the clinician. This review will provide a brief summary of the current status of antimicrobial resistance, its molecular mechanisms and the impact on the current status of M. genitalium treatment.
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Affiliation(s)
- Thomas E van der Schalk
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Joyce F Braam
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Johannes G Kusters
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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Piñeiro L, Idigoras P, de la Caba I, López-Olaizola M, Cilla G. Tratamiento antibiótico dirigido en infecciones por Mycoplasma genitalium: análisis de mutaciones asociadas con resistencia a macrólidos y fluoroquinolonas. Enferm Infecc Microbiol Clin 2019; 37:394-397. [DOI: 10.1016/j.eimc.2018.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 12/18/2022]
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Sweeney EL, Trembizki E, Bletchly C, Bradshaw CS, Menon A, Francis F, Langton-Lockton J, Nimmo GR, Whiley DM. Levels of Mycoplasma genitalium Antimicrobial Resistance Differ by Both Region and Gender in the State of Queensland, Australia: Implications for Treatment Guidelines. J Clin Microbiol 2019; 57:e01555-18. [PMID: 30602443 PMCID: PMC6425175 DOI: 10.1128/jcm.01555-18] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/15/2018] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma genitalium is frequently associated with urogenital and rectal infections, with the number of cases of macrolide-resistant and quinolone-resistant M. genitalium infection continuing to increase. In this study, we examined the levels of resistance to these two common antibiotic treatments in geographically distinct locations in Queensland, Australia. Samples were screened for macrolide resistance-associated mutations using a commercially available kit (ResistancePlus MG; SpeeDx), and quinolone resistance-associated mutations were identified by PCR and DNA sequencing. Comparisons between antibiotic resistance mutations and location/gender were performed. The levels of M. genitalium macrolide resistance were high across both locations (62%). Quinolone resistance mutations were found in ∼10% of all samples, with a number of samples harboring mutations conferring resistance to both macrolides and quinolones. Quinolone resistance was higher in southeast Queensland than in north Queensland, and this was consistent in both males and females (P = 0.007). The M. genitalium isolates in rectal swab samples from males harbored high levels of macrolide (75.9%) and quinolone (19%) resistance, with 15.5% harboring resistance to both classes of antibiotics. Overall, the lowest observed level of resistance was to quinolones in females from north Queensland (1.6%). These data highlight the high levels of antibiotic resistance in M. genitalium isolates within Queensland and the challenges faced by sexually transmitted infection clinicians in managing these infections. The data do, however, show that the levels of antibiotic resistance may differ between populations within the same state, which has implications for clinical management and treatment guidelines. These findings also support the need for ongoing antibiotic resistance surveillance and tailored treatment.
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Affiliation(s)
- E L Sweeney
- The University of Queensland Centre for Clinical Research (UQ-CCR), The University of Queensland, Brisbane, Queensland, Australia
| | - E Trembizki
- The University of Queensland Centre for Clinical Research (UQ-CCR), The University of Queensland, Brisbane, Queensland, Australia
| | - C Bletchly
- Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia
| | - C S Bradshaw
- Melbourne Sexual Health Centre, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - A Menon
- Townsville Sexual Health Service, Townsville, Queensland, Australia
| | - F Francis
- Pathology Queensland Townsville Laboratory, Townsville, Queensland, Australia
| | | | - G R Nimmo
- Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia
| | - D M Whiley
- The University of Queensland Centre for Clinical Research (UQ-CCR), The University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia
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Muller EE, Mahlangu MP, Lewis DA, Kularatne RS. Macrolide and fluoroquinolone resistance-associated mutations in Mycoplasma genitalium in Johannesburg, South Africa, 2007-2014. BMC Infect Dis 2019; 19:148. [PMID: 30760230 PMCID: PMC6373000 DOI: 10.1186/s12879-019-3797-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 02/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial resistance in Mycoplasma genitalium is rising globally with resultant clinical treatment failure. We investigated the prevalence of mutations in the macrolide and fluoroquinolone resistance-determining regions of M. genitalium in Johannesburg, South Africa, and ascertained their association with HIV serostatus. METHODS Stored M. genitalium positive specimens, collected from STI and HIV patients enrolled in the Gauteng STI National Microbiological Surveillance programme (2007-2014) and a large HIV outpatient clinic-based study (2007) in Johannesburg, were tested for antimicrobial resistance. RESULTS We determined the prevalence of 23S rRNA gene mutations conferring macrolide resistance and mutations in the quinolone resistance-determining regions (QRDR) of the gyrA and parC genes in 266 M. genitalium positive DNA extracts. No macrolide resistance-associated mutations were detected in any of the specimens analysed. QRDR mutations with known M. genitalium-associated fluoroquinolone resistance were not detected in gyrA, however, one specimen (0.4%) contained a D87Y amino acid alteration in parC, which has been linked to fluoroquinolone treatment failure. The most common parC amino acid change detected, of unknown clinical significance, was P62S (18.8%). We found no significant association between QRDR mutations in M. genitalium and HIV-infection. CONCLUSIONS Ongoing antimicrobial resistance surveillance in M. genitalium is essential, as macrolide resistance may emerge given the recent incorporation of azithromycin into the 2015 South African national STI syndromic management guidelines.
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Affiliation(s)
- Etienne E Muller
- Sexually Transmitted Infections Section, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
| | - Mahlape P Mahlangu
- Sexually Transmitted Infections Section, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - David A Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity and Sydney Medical School-Westmead, University of Sydney, Sydney, Australia
| | - Ranmini S Kularatne
- Sexually Transmitted Infections Section, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Maduna LD, Laumen JGE, Radebe O, Kock MM, Peters RPH. Failure of syndromic management due to drug-resistant Mycoplasma genitalium infection in South Africa: a case report. Int J STD AIDS 2019; 30:519-521. [DOI: 10.1177/0956462418820745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of management failure of male urethritis syndrome due to macrolide-resistant Mycoplasma genitalium in South Africa. We detected mutations in 23S rRNA and one of the quinolone resistance-determining regions. This report confirms that drug-resistant M. genitalium infection can undermine the effectiveness of syndromic management in Africa.
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Affiliation(s)
- Liteboho D Maduna
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Jolein GE Laumen
- Department of Medical Microbiology, School of Public Health & Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Oscar Radebe
- Anova Health Institute, Johannesburg, South Africa
| | - Marleen M Kock
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Remco PH Peters
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Department of Medical Microbiology, School of Public Health & Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
- Anova Health Institute, Johannesburg, South Africa
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41
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Glaser AM, Geisler WM, Ratliff AE, Xiao L, Waites KB, Gaisa M. Two cases of multidrug-resistant genitourinary Mycoplasma genitalium infection successfully eradicated with minocycline. Int J STD AIDS 2019; 30:512-514. [PMID: 30999836 DOI: 10.1177/0956462418816757] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mycoplasma genitalium (MG) infection is a sexually transmitted infection that causes up to 25% of nongonococcal urethritis (NGU). MG strains carrying genetic markers of antimicrobial resistance that may affect treatment outcomes are increasingly recognized as a public health concern. We present two cases of persistent MG NGU with strains carrying both macrolide and quinolone resistance-associated mutations that were eradicated successfully by an extended course of minocycline.
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Affiliation(s)
- Allison M Glaser
- 1 Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William M Geisler
- 2 Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy E Ratliff
- 3 Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Li Xiao
- 4 Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ken B Waites
- 3 Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael Gaisa
- 1 Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Read TRH, Jensen JS, Fairley CK, Grant M, Danielewski JA, Su J, Murray GL, Chow EPF, Worthington K, Garland SM, Tabrizi SN, Bradshaw CS. Use of Pristinamycin for Macrolide-Resistant Mycoplasma genitalium Infection. Emerg Infect Dis 2019; 24:328-335. [PMID: 29350154 PMCID: PMC5782881 DOI: 10.3201/eid2402.170902] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
High levels of macrolide resistance and increasing fluoroquinolone resistance are found in Mycoplasma genitalium in many countries. We evaluated pristinamycin for macrolide-resistant M. genitalium in a sexual health center in Australia. Microbiologic cure was determined by M. genitalium–specific 16S PCR 14–90 days after treatment began. Of 114 persons treated with pristinamycin, infection was cured in 85 (75%). This percentage did not change when pristinamycin was given at daily doses of 2 g or 4 g or at 3 g combined with 200 mg doxycycline. In infections with higher pretreatment bacterial load, treatment was twice as likely to fail for each 1 log10 increase in bacterial load. Gastrointestinal side effects occurred in 7% of patients. Pristinamycin at maximum oral dose, or combined with doxycycline, cured 75% of macrolide-resistant M. genitalium infections. Pristinamycin is well-tolerated and remains an option where fluoroquinolones have failed or cannot be used.
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Surveillance of the prevalence of macrolide and/or fluoroquinolone resistance-associated mutations in Mycoplasma genitalium in Japan. J Infect Chemother 2018; 24:861-867. [PMID: 30190106 DOI: 10.1016/j.jiac.2018.08.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022]
Abstract
To clarify the status of macrolide and fluoroquinolone resistance of clinical strains of Mycoplasma genitalium in Japan, we amplified portions of the gyrA, parC, and 23S rRNA genes from DNAs in 627 first-voided urine specimens collected from men with M. genitalium-positive urethritis who visited clinics mainly in Sendai, Tokyo, and Osaka, Japan, from 2013 to 2017, by PCR and sequenced. The incidence of single amino acid changes at Met95 or Asp99 in GyrA increased chronologically and was approximately 10% from 2015 onward. The incidence of amino acid changes at Ser83 or Asp87 in ParC was approximately 50% in 2013 but increased to 60-70% from 2014 to 2017. The incidence of mutations at A2071 or A2072 in the 23S rRNA gene increased chronologically and reached over 70% in 2017. The prevalence of M. genitalium harboring alterations in ParC and mutations in the 23S rRNA gene increased and was approximately 50% in 2016 and 2017. The prevalence of M. genitalium with alterations in both GyrA and ParC and mutations in the 23S rRNA gene, which could be associated with treatment failures with the sitafloxacin and azithromycin regimens, were approximately 15% and 10% in 2016 and 2017, respectively. The prevalence of M. genitalium with genetic alterations associated with resistance to fluoroquinolones and/or macrolides is increasing rapidly in Japan. We must prevent the further selection of multi-drug-resistant M. genitalium so that M. genitalium infections will not become untreatable.
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44
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Hamasuna R, Le PT, Kutsuna S, Furubayashi K, Matsumoto M, Ohmagari N, Fujimoto N, Matsumoto T, Jensen JS. Mutations in ParC and GyrA of moxifloxacin-resistant and susceptible Mycoplasma genitalium strains. PLoS One 2018; 13:e0198355. [PMID: 29883482 PMCID: PMC5993279 DOI: 10.1371/journal.pone.0198355] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/17/2018] [Indexed: 11/19/2022] Open
Abstract
Macrolide or fluoroquinolone-resistant Mycoplasma genitalium is spreading worldwide. We aimed to determine the influence of single nucleotide polymorphisms (SNPs) in the quinolone resistance determining regions (QRDR) of parC and gyrA in cultured M. genitalium strains. In addition, we examined the prevalence of macrolide- and fluoroquinolone resistance mediating mutations in specimens collected from Japanese male patients with urethritis in two time-periods between 2005–2009 and 2010–2017, respectively, by sequencing the QRDR of parC and gyrA and domain V of the 23S rRNA gene. The minimum inhibitory concentrations (MIC) of moxifloxacin, sitafloxacin, ciprofloxacin, levofloxacin, doxycycline, minocycline, azithromycin and clarithromycin were determined in 23 M. genitalium strains. Three cultured strains had elevated MICs for moxifloxacin at 16, 4 and 2 mg/L and had SNPs with the amino-acid change Ser83→Ile in ParC (p<0.001) and 3 kinds of SNPs with amino-acid changes Asp99→Asn, Gly93→Cys and Met95→Ile in GyrA, respectively. Among a total of 148 M. genitalium positive urine specimens, the prevalence of A2058G and A2059G SNPs in the 23S rRNA gene and any SNPs in ParC increased from 4.8% and 22.6% in 2005–2009 to 42.2% and 53.1% in 2010–2017, respectively. If M. genitalium is considered multi-drug resistant in clinical specimens carrying SNPs in the 23S rRNA gene and Ser83→Ile in ParC, the prevalence of multi-drug resistance is 12.5% in 2010–2017 in Japan. In conclusion, the SNP resulting in Ser83→Ile in ParC is closely related to moxifloxacin resistance even though other factors may also affect treatment outcomes by moxifloxacin. The prevalence of circulating multi-drug resistant M. genitalium strains with macrolide- and fluoroquinolone-resistance is dramatically increasing in Japan.
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Affiliation(s)
- Ryoichi Hamasuna
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
- * E-mail:
| | - Phuong Thi Le
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, International Health Care Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Masahiro Matsumoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, International Health Care Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tetsuro Matsumoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Jorgen Skov Jensen
- Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
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Mycoplasma genitalium Antibiotic Resistance-Mediating Mutations in Canadian Women With or Without Chlamydia Trachomatis Infection. Sex Transm Dis 2018; 44:433-435. [PMID: 28608794 DOI: 10.1097/olq.0000000000000617] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Testing remnant Aptima specimens from women infected with Chlamydia trachomatis detected 13.4% (53/396) with Mycoplasma genitalium compared with 5.4% (22/406) in matched C. trachomatis-negative women. Overall, 9.4% (provincial ranges of 3-20%) were infected with M. genitalium and resistance mediating mutations were found in 47.3% (26/55) to macrolides and 1.9% (1/53) to fluoroquinolones by sequencing.
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46
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Le Roy C, Hénin N, Pereyre S, Bébéar C. Fluoroquinolone-Resistant Mycoplasma genitalium, Southwestern France. Emerg Infect Dis 2018; 22:1677-9. [PMID: 27533360 PMCID: PMC4994369 DOI: 10.3201/eid2209.160446] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Fookes MC, Hadfield J, Harris S, Parmar S, Unemo M, Jensen JS, Thomson NR. Mycoplasma genitalium: whole genome sequence analysis, recombination and population structure. BMC Genomics 2017; 18:993. [PMID: 29281972 PMCID: PMC5745988 DOI: 10.1186/s12864-017-4399-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/19/2017] [Indexed: 01/10/2023] Open
Abstract
Background Although Mycoplasma genitalium is a common sexually transmitted pathogen causing clinically distinct diseases both in male and females, few genomes have been sequenced up to now, due mainly to its fastidious nature and slow growth. Hence, we lack a robust phylogenetic framework to provide insights into the population structure of the species. Currently our understanding of the nature and diversity of M. genitalium relies on molecular tests targeting specific genes or regions of the genome and knowledge is limited by a general under-testing internationally. This is set against a background of drug resistance whereby M. genitalium has developed resistance to mainly all therapeutic antimicrobials. Results We sequenced 28 genomes of Mycoplasma genitalium from temporally (1980–2010) and geographically (Europe, Japan, Australia) diverse sources. All the strain showed essentially the same genomic content without any accessory regions found. However, we identified extensive recombination across their genomes with a total of 25 regions showing heightened levels of SNP density. These regions include the MgPar loci, associated with host interactions, as well as other genes that could also be involved in this role. Using these data, we generated a robust phylogeny which shows that there are two main clades with differing degrees of genomic variability. SNPs found in region V of 23S rRNA and parC were consistent with azithromycin/erythromycin and fluoroquinolone resistances, respectively, and with their phenotypic MIC data. Conclusions The sequence data here generated is essential for designing rational approaches to type and track Mycoplasma genitalium as antibiotic resistance increases. It represents a first approach to its population genetics to better appreciate the role of this organism as a sexually transmitted pathogen. Electronic supplementary material The online version of this article (10.1186/s12864-017-4399-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria C Fookes
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK.
| | - James Hadfield
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Simon Harris
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Surendra Parmar
- Clinical Microbiology and Public Health Laboratory, National Infection Service, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jørgen S Jensen
- Division for Infection Preparedness, Bacteria, Parasites, and Fungi, Research Unit for Reproductive Tract Microbiology, Statens Serum Institute, Copenhagen, Denmark
| | - Nicholas R Thomson
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK. .,London School of Hygiene and Tropical Medicine, London, UK.
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Hadad R, Golparian D, Lagos AC, Ljungberg J, Nilsson P, Jensen JS, Fredlund H, Unemo M. Macrolide and fluoroquinolone resistance in Mycoplasma genitalium in two Swedish counties, 2011-2015. APMIS 2017; 126:123-127. [PMID: 29235145 DOI: 10.1111/apm.12792] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/08/2017] [Indexed: 01/19/2023]
Abstract
Mycoplasma genitalium, causing non-gonococcal non-chlamydial urethritis and associated with cervicitis, has developed antimicrobial resistance (AMR) to both the macrolide azithromycin (first-line treatment) and the fluoroquinolone moxifloxacin (second-line treatment). Our aim was to estimate the prevalence of resistance, based on genetic AMR determinants, to these antimicrobials in the M. genitalium population in two Swedish counties, Örebro and Halland, 2011-2015. In total, 672 M. genitalium positive urogenital samples were sequenced for 23S rRNA and parC gene mutations associated with macrolide and fluoroquinolone resistance, respectively. Of the samples, 18.6% and 3.2% in Örebro and 15.2% and 2.7% in Halland contained mutations associated with macrolide and fluoroquinolone resistance, respectively. The predominating resistance-associated mutations in the 23S rRNA gene was A2059G (n = 39) in Örebro and A2058G (n = 13) and A2059G (n = 13) in Halland. The most prevalent possible resistance-associated ParC amino acid alterations were S83I (n = 4) in Örebro and S83N (n = 2) in Halland. Resistance-associated mutations to both macrolides and fluoroquinolones were found in 0.7% of samples. Our findings emphasize the need for routine AMR testing, at a minimum for macrolide resistance, of all M. genitalium-positive samples and regular national and international surveillance of AMR in M. genitalium, to ensure effective patient management and rational antimicrobial use.
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Affiliation(s)
- Ronza Hadad
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Örebro University, Örebro, Sweden
| | - Daniel Golparian
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Örebro University, Örebro, Sweden
| | - Amaya C Lagos
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Örebro University, Örebro, Sweden
| | - Johan Ljungberg
- Department of Infectious Diseases, Hospital of Halmstad, Halmstad, Sweden
| | - Peter Nilsson
- Department of Clinical Microbiology & Infection Control, Hospital of Halmstad, Halmstad, Sweden
| | - Jörgen S Jensen
- Department of Microbiology and Infection Control, Sexually Transmitted Infections, Research and Development, Statens Serum Institut, Copenhagen, Denmark
| | - Hans Fredlund
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Örebro University, Örebro, Sweden
| | - Magnus Unemo
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Örebro University, Örebro, Sweden
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Le Roux MC, Mafunise M, de Villiers BE, Ditsele RM. Antimicrobial susceptibility ofMycoplasma genitaliumisolates from Pretoria, South Africa in 2012 and 2016. S Afr J Infect Dis 2017. [DOI: 10.1080/23120053.2017.1391505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Marie C Le Roux
- Department of Microbiological Pathology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Maanda Mafunise
- Department of Microbiological Pathology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Barbara E de Villiers
- Department of Microbiological Pathology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Ramalau Mm Ditsele
- Department of Microbiological Pathology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- NHLS Dr George Mukhari Academic Hospital
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50
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In Vitro Activities of Gepotidacin (GSK2140944) and Other Antimicrobial Agents against Human Mycoplasmas and Ureaplasmas. Antimicrob Agents Chemother 2017; 61:AAC.01064-17. [PMID: 28784668 DOI: 10.1128/aac.01064-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 07/31/2017] [Indexed: 11/20/2022] Open
Abstract
Gepotidacin, a novel first-in-class triazaacenaphthylene topoisomerase II inhibitor, was tested against 85 type strains and clinical isolates of Mycoplasma pneumoniae, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma parvum, and Ureaplasma urealyticum in comparison to levofloxacin, moxifloxacin, azithromycin or clindamycin, and tetracycline. Gepotidacin MIC90s (μg/ml) were 0.125 (M. pneumoniae), 0.032 (M. genitalium), 2 (M. hominis), and 8 (Ureaplasma species). Gepotidacin activity was not affected by resistance to fluoroquinolones, tetracyclines, or macrolides in the strains tested. Gepotidacin merits further study for treating infections caused by these organisms.
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