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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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2
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Sokoll PR, Migliavaca CB, Siebert U, Schmid D, Arvandi M. Prevalence of Mycoplasma genitalium infection among HIV PrEP users: a systematic review and meta-analysis. Sex Transm Infect 2023:sextrans-2022-055687. [PMID: 36759179 DOI: 10.1136/sextrans-2022-055687] [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: 11/07/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES To summarise the prevalence of Mycoplasma genitalium (MG) and antibiotic-resistant MG infection among HIV pre-exposure prophylaxis (PrEP) users. METHODS We searched MEDLINE, Embase, Web of Science and Global Index Medicus up to 30 September 2022. We included studies reporting the prevalence of MG and/or antibiotic-resistant MG infection among PrEP users. Two reviewers independently searched for studies and extracted data. A systematic review with random-effects meta-analysis was performed to quantitatively summarise the results of included studies. The critical appraisal of included studies was conducted with the Joanna Briggs Institute checklist for prevalence studies and the quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of 15 studies were included in the systematic review, with 2341 individuals taking PrEP. Studies were conducted in high-income level countries between 2014 and 2019. Median age of participants varied from 23.5 to 40 years. The majority were men (85%) and among them, 93% were men who have sex with men. To identify MG, urine samples were analysed in 14 studies, rectal or anal swabs in 12 studies, oral or pharyngeal swabs in 9 studies, and urethral or vaginal in 3 studies. The pooled point prevalence of MG among PrEP users was 16.7% (95% CI 13.6% to 20.3%; 95% prediction interval (95% PI) 8.2% to 31.1%). The pooled point prevalence of macrolide-resistant infections was 82.6% (95% CI 70.1% to 90.6%; 95% PI 4.7% to 99.8%) and the prevalence of fluoroquinolone-resistant infections was 14.3% (95% CI 1.8% to 42.8%). Individuals taking PrEP have a higher chance of being infected with MG compared with those not taking PrEP (OR 2.30; 95% CI 1.6 to 3.4). The quality of evidence was very low to moderate. CONCLUSION We observed a high prevalence of MG and its macrolide resistance among PrEP users, highlighting the need to reinforce prevention strategies against sexually transmitted infections in this population. PROSPERO REGISTRATION NUMBER CRD42022310597.
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Affiliation(s)
- Paulo Roberto Sokoll
- Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Celina Borges Migliavaca
- Health Technology Assessment Institute (IATS), Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA). Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Daniela Schmid
- Division for Quantitative Methods in Public Health and Health Services Research, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Marjan Arvandi
- Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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3
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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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4
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Clinical Performance of Three Commercial Molecular Diagnostic Assays for the Detection of Fluoroquinolone Resistance-Associated Mutations in Mycoplasma genitalium. J Clin Microbiol 2022; 60:e0113522. [PMID: 36321820 PMCID: PMC9769504 DOI: 10.1128/jcm.01135-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The high prevalence of macrolide resistance in Mycoplasma genitalium results in an increased reliance on moxifloxacin, the second-line treatment; however, moxifloxacin resistance has also emerged. Because assays that can detect fluoroquinolone resistance-associated mutations will be useful for the management of macrolide-resistant M. genitalium infections, we evaluated the performance of three commercial assays (the Allplex MG & MoxiR Assay [Seegene], LightMix Modular parC kit [TIBMOLBIOL], and MGMO qPCR [NYtor) in comparison with parC gene Sanger sequencing used as the reference. Between January 2018 and December 2020, remnants of M. genitalium-positive clinical specimens received at the French National Reference Center for Bacterial Sexually Transmitted Infections were collected if a Sanger sequencing result was obtained for the parC gene. Overall, 368 M. genitalium-positive specimens were assessed. The clinical sensitivities for the detection of the ParC mutations that are likely of clinical significance were 91.8% (95% CI = 83.2 to 96.2), 98.6% (95% CI = 92.4 to 99.8), and 94.4% (95% CI = 86.6 to 97.8) for the Allplex MG & MoxiR, LightMix Modular parC, and MGMO qPCR kits, respectively, with no significant difference between the three kits. The clinical specificity of the Allplex MG & MoxiR and MGMO qPCR kits was 100% (95% CI = 97.7 to 100 and 98.7 to 100, respectively), which was significantly higher than the specificity of the LightMix Modular parC kit of 95.4% (95%CI = 92.3 to 97.3), for which the interpretation of melting curves may be misleading. These kits should be useful for the selection of antimicrobials in macrolide-resistant M. genitalium infections, although further developments may be necessary because parC mutations involved in fluoroquinolone resistance have not been precisely determined.
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5
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Braam JF, Zondag HCA, van Dam AP, de Vries HJC, Vergunst C, Hetem D, Schim van der Loeff MF, Bruisten SM. Prevalence of fluoroquinolone resistance-associated mutations in Mycoplasma genitalium among clients of two sexual health centres in the Netherlands: a cross-sectional study. BMJ Open 2022; 12:e066368. [PMID: 36600371 PMCID: PMC9730358 DOI: 10.1136/bmjopen-2022-066368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aimed to determine the prevalence of fluoroquinolone resistance-associated mutations (QRAMs) in Mycoplasma genitalium (MG) among clients of two sexual health centres (SHCs) in the Netherlands. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS Between 2018 and 2019, 669 clients with MG were included from two previous studies: 375 male clients with urethritis from the SHC in Amsterdam; and 294 clients (male and female) from the SHC in Amsterdam and The Hague. Urogenital and anal samples (705 in total) that tested positive for MG by nucleic acid amplification tests were selected. OUTCOME MEASURES The presence of QRAM was detected by an MG-QRAM PCR targeting four mutations in the parC gene and investigated by sequence analysis of relevant regions of the gyrA and parC genes. Possible risk factors for the presence of QRAM were investigated. RESULTS We found QRAM in 58 of 669 (9%) clients with an MG infection: 36 of 375 (10%) in the study population of men with urethritis and 22 of 294 (7%) in the study population of other clients (including both men and women; p=0.334). Most prevalent mutations in the parC gene were S83I and D87N, occurring in 31 of 60 (52%) and 20 of 60 (33%) samples, respectively. Factors associated with the presence of QRAM were: men who have sex with men (adjusted OR (aOR) 3.4, 95% CI 1.7 to 6.9) and Asian origin (aOR 2.5, 95% CI 1.2 to 5.6). Multidrug resistance (QRAM plus macrolide resistance-associated mutations) was found in 46 of 669 (7%) clients. CONCLUSIONS Nine per cent of MG-positive clients from two Dutch SHCs had QRAM. New treatment strategies and antibiotics are needed to treat symptomatic patients with multidrug-resistant MG.
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Affiliation(s)
- Joyce F Braam
- Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Helene C A Zondag
- Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Department of Medical Microbiology, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Alje P van Dam
- Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Department of Medical Microbiology, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Henry J C de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Clarissa Vergunst
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Noordwest Ziekenhuisgroep-Locatie Den Helder, Den Helder, The Netherlands
| | - David Hetem
- Department of Medical Microbiology, Medical Centre Haaglanden, The Hague, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Sylvia M Bruisten
- Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Department of Medical Microbiology, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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6
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Pereyre S, Laurier-Nadalié C, Le Roy C, Guiraud J, Dolzy A, Hénin N, Gardette M, Bébéar C. Prevalence of macrolide and fluoroquinolone resistance-associated mutations in Mycoplasma genitalium in metropolitan and overseas France. Sex Transm Infect 2022; 99:254-260. [PMID: 36413349 DOI: 10.1136/sextrans-2022-055466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/05/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveLimited macrolide and fluoroquinolone resistance data are available in France for Mycoplasma genitalium. We performed a multicentre cross-sectional study to investigate the prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium-positive patients in metropolitan France between 2018 and 2020 and in overseas France in 2018 and 2019.MethodsEach year, a 1-month prospective collection of M. genitalium-positive specimens was proposed to metropolitan French microbiology diagnostic laboratories, and a similar 3-month collection was proposed to overseas French laboratories. Resistance-associated mutations were detected using commercial kits and sequencing.ResultsA total of 1630 M. genitalium-positive specimens were analysed. In metropolitan France, the prevalence of macrolide resistance-associated mutations ranged between 34.7% (95% CI 29.4% to 40.4%) and 42.9% (95% CI 37.1% to 49.0%) between 2018 and 2020 and was significantly higher in men (95% CI 52.4% to 60.2%) than in women (95% CI 15.9% to 22.2%) (p<0.001). These prevalences were significantly higher than those of 6.1% (95% CI 3.7% to 10.3%) and 14.7% (95% CI 10.9% to 19.6%) observed in overseas France in 2018 and 2019 (p<0.001), where no difference between genders was noted. The prevalence of fluoroquinolone resistance-associated mutations was also significantly higher in metropolitan France (14.9% (95% CI 11.2% to 19.5%) to 16.1% (95% CI 12.1% to 21.2%)) than in overseas France (1.3% (95% CI 0.4% to 3.7%) and 2.6% (95% CI 1.3% to 5.3%) in 2018 and 2019, respectively) (p<0.001), with no difference between men and women regardless of the location.ConclusionThis study reports the high prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium in metropolitan France and highlights the contrast with low prevalence in overseas France. In metropolitan France, macrolide resistance-associated mutation prevalence was three times higher in men than in women, which was likely to be driven by the proportion of men who have sex with men. This suggests that gender and sexual practice should also be taken into account for the management of M. genitalium infections.
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7
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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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8
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parC Variants in Mycoplasma genitalium: Trends over Time and Association with Moxifloxacin Failure. Antimicrob Agents Chemother 2022; 66:e0027822. [PMID: 35475636 DOI: 10.1128/aac.00278-22] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Prevalence, trends, and treatment outcome estimates were generated for parC variants in macrolide-resistant Mycoplasma genitalium. Among 539 cases, the most common amino acid change was S83I, which increased from 13% in 2012 to 2013, to 23% in 2019 to 2020 (Ptrend = 0.046). From 381 moxifloxacin treatments, failure occurred in 58.7% (95% confidence interval [CI], 46.7 to 69.9) of cases with S83I. Other changes affecting S83 or D87 were uncommon and minor contributors to failure. The absence of S83I was highly predictive of moxifloxacin cure (96.4%; 95% CI, 93.7 to 98.2), highlighting diagnostic potential.
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9
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Vodstrcil LA, Plummer EL, Doyle M, Murray GL, Bodiyabadu K, Jensen JS, Whiley D, Sweeney E, Williamson DA, Chow EPF, Fairley CK, Bradshaw CS. Combination therapy for Mycoplasma genitalium, and new insights into the utility of parC mutant detection to improve cure. Clin Infect Dis 2022; 75:813-823. [PMID: 34984438 DOI: 10.1093/cid/ciab1058] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium (MG) infection is challenging to cure due to rising antimicrobial resistance and limited treatment options. METHODS This was a prospective evaluation of the efficacy and tolerability of resistance-guided combination antimicrobial therapy for MG-treatment at Melbourne Sexual Health Centre (August 2019-December 2020). All patients received 7-days doxycycline prior to combination therapy based on the macrolide-resistant profile. Macrolide-susceptible infections received combination doxycycline+azithromycin (1g day-1, 500mg days-2-4) and macrolide-resistant infections combination doxycycline+moxifloxacin (400mg daily 7-days). Adherence and adverse effects were recorded at test-of-cure, recommended 14-28-days after antimicrobial completion. Sequencing was performed to determine the prevalence of single nucleotide polymorphisms (SNPs) in the parC gene and their association with moxifloxacin-treatment outcomes in macrolide-resistant infections. RESULTS Of 100 patients with macrolide-susceptible MG treated with doxycycline+azithromycin, 93 were cured (93.0%; 95%CI:86.1%-97.1%). Of 247 patients with macrolide-resistant MG receiving doxycycline+moxifloxacin, 210 were cured (85.0%; 95%CI:80.0%-89.2%). parC sequencing was available for 164 (66%) macrolide-resistant infections; 29% had SNPs at parC S83 or D87 (23% S83I). The absence of SNPs at parC S83/D87 was associated with 98.3% cure (95%CI:93.9-99.8%) following doxycycline+moxifloxacin. The presence of the parC S83I-SNP was associated with failure in 62.5% (95%CI:45.8-77.3%). Side-effects were common (40-46%) and predominantly mild and gastrointestinal. CONCLUSION Combination doxycycline+azithromycin achieved high cure for macrolide-susceptible infections. However, in the context of a high prevalence of the parC S83I mutation (23%) in macrolide-resistant infections, doxycycline+moxifloxacin cured only 85%Infections that were wildtype for S83/D87 experienced high cure following doxycycline+moxifloxacin, supporting the use of a parC-resistance/susceptibility testing strategy in clinical care.
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Affiliation(s)
- Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Erica L Plummer
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Gerald L Murray
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Kaveesha Bodiyabadu
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Jorgen S Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark
| | - David Whiley
- The University of Queensland Centre for Clinical Research (UQ-CCR), Queensland, Australia.,Pathology Queensland Central Laboratory, Queensland, Australia
| | - Emma Sweeney
- The University of Queensland Centre for Clinical Research (UQ-CCR), Queensland, Australia
| | - Deborah A Williamson
- Department of Microbiology, Royal Melbourne Hospital, Melbourne, Australia.,Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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10
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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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Analysis of fluoroquinolone-resistance using MIC determination and homology modelling of ParC of contemporary Mycoplasma genitalium strains. J Infect Chemother 2021; 28:377-383. [PMID: 34836778 DOI: 10.1016/j.jiac.2021.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/22/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The mechanisms of fluoroquinolone-resistance of Mycoplasma genitalium were analysed by a new method. METHODS M. genitalium strains from urinary sediments of patients with urethritis were isolated and examined antimicrobial susceptibilities and the mutations in ParC, GyrA and 23S rRNA. Docking models between gyrase and topoisomerase IV with sitafloxacin showed that two binding modes in which the amine moiety at the C-7 position rotated could be constructed. RESULTS Among 18 strains, 13 strains had mutations with amino-acid changes at Serine 83 in ParC. The MICs of moxifloxacin or sitafloxacin for three strains with only S83I in ParC were 2, 1 and 8 mg/L (moxifloxacin) or 0.13, 0.13 and 1 mg/L (sitafloxacin), respectively. In contrast, the MICs of moxifloxacin or sitafloxacin for 3 strain with S83N in ParC were 0.25, 0.13 and 0.25 mg/L (moxifloxacin) or 0.06, 0.03, and 0,03 mg/L (sitafloxacin), respectively, not significantly different from wild-type isolates. The docking model of sitafloxacin and topoisomerase IV showed that the oxygen atom at the gamma position of Serine 83 of ParC interacted with the sitafloxacin carboxylate moiety. When the S83I substitution occurs, the isoleucine side chain is lipophilic and the residue hydropathy changes from hydrophilicity to hydrophobicity and important H-bond interactions between serine and the carboxylate moiety are lost. When the serine 83 to asparagine substitution (S83N) occurred, the asparagine side chain is hydrophilic and the residue hydropathy does not change. CONCLUSION The docking model suggests that Ser83 replacements causes attenuation or loss of activity of fluoroquinolones such as sitafloxacin.
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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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Day MJ, Cole MJ, Fifer H, Woodford N, Pitt R. Detection of markers predictive of macrolide and fluoroquinolone resistance in Mycoplasma genitalium from patients attending sexual health services. Sex Transm Infect 2021; 98:215-218. [PMID: 34088790 DOI: 10.1136/sextrans-2020-054897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/09/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study sought to provide data on the prevalence of macrolide (23S rRNA) and fluoroquinolone (parC) resistance-associated mutations seen in Mycoplasma genitalium-positive specimens received in the UK national reference laboratory. METHODS In total, 2580 clinical specimens from patients with suspected or confirmed M. genitalium infection were received at the national reference laboratory between September 2017 and November 2018. M. genitalium-positive clinical specimens were identified using a reverse transcription-PCR targeting two M. genitalium genes: MgPa and gap. Resistance-associated single nucleotide poylmorphisms were sought in all positive specimens by sequence analysis of the 23S rRNA and parC genes. RESULTS Eighteen per cent (458 of 2580) of clinical specimens were positive for M. genitalium and 389 had sequence data for both macrolide and fluoroquinolone resistance markers. Of these, 71% (275 of 389) had macrolide resistance-associated mutations, 8% (31 of 389) had fluoroquinolone resistance-associated mutations (S83I/R and D87Y/N) and 7% (26 of 389) had mutations associated with resistance to both antimicrobials. Only 28% (108 of 389) had no mutations associated with resistance to either class of antibiotic. Five specimens had mutations of unknown clinical significance in the parC gene (eg, G81C and S83N). CONCLUSIONS Mutations associated with resistance to macrolides were very frequent. By contrast, susceptibility to the second-line treatment, moxifloxacin (a fluoroquinolone), was estimated at 92% based on the absence of resistance-associated mutations. The few specimens with mutations of unknown clinical significance in the parC gene were excluded from the analysis and so the actual level of fluoroquinolone susceptibility may be slightly lower than that reported here. Surveillance of antimicrobial resistance in M. genitalium is imperative for this to remain a treatable infection.
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Affiliation(s)
- Michaela Joanne Day
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), National Infection Service, Public Health England, London, UK
| | - Michelle Jayne Cole
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), National Infection Service, Public Health England, London, UK
| | - Helen Fifer
- Blood Safety, Hepatitis, Sexually-Transmitted Infections and HIV Division, National Infection Service, Public Health England, London, UK
| | - Neil Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), National Infection Service, Public Health England, London, UK
| | - Rachel Pitt
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), National Infection Service, Public Health England, London, UK
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High Prevalence of Vaginal and Rectal Mycoplasma genitalium Macrolide Resistance Among Female Sexually Transmitted Disease Clinic Patients in Seattle, Washington. Sex Transm Dis 2021; 47:321-325. [PMID: 32304528 DOI: 10.1097/olq.0000000000001148] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are increasingly recognized as common infections among women. Little is known about the prevalence of rectal Mycoplasma genitalium (MG), rectal MG/CT/GC coinfection, or MG antimicrobial resistance patterns among women. METHODS In 2017 to 2018, we recruited women at high risk for CT from Seattle's municipal sexually transmitted disease clinic. Participants self-collected vaginal and rectal specimens for CT/GC nucleic acid amplification testing. We retrospectively tested samples for vaginal and rectal MG using nucleic acid amplification testing and tested MG-positive specimens for macrolide resistance-mediating mutations (MRM) and ParC quinolone resistance-associated mutations (QRAMs). RESULTS Of 50 enrolled women, 13 (26%) tested positive for MG, including 10 (20%) with vaginal MG and 11 (22%) with rectal MG; 8 (62%) had concurrent vaginal/rectal MG. Five (38%) were coinfected with CT, none with GC. Only 2 of 11 women with rectal MG reported anal sex in the prior year. Of MG-positive specimens, 100% of rectal and 89% of vaginal specimens had an MRM. There were no vaginal or rectal MG-positive specimens with ParC QRAMs previously associated with quinolone failure. Five MG-infected women received azithromycin for vaginal CT, 4 of whom had a MG MRM detected in their vaginal and/or rectal specimens. CONCLUSIONS We observed a high prevalence of macrolide-resistant vaginal and rectal MG among a population of women at high risk for CT. This study highlights how the use of antimicrobials designed to treat an identified infection-in this case, CT-could influence treatment outcomes and antimicrobial susceptibility in other unidentified infections.
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15
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Bodiyabadu K, Danielewski J, Garland SM, Machalek DA, Bradshaw CS, Birnie J, Ebeyan S, Lundgren M, Murray G. Detection of parC gene mutations associated with quinolone resistance in Mycoplasma genitalium: evaluation of a multiplex real-time PCR assay. J Med Microbiol 2021; 70:001257. [PMID: 33612146 PMCID: PMC8346731 DOI: 10.1099/jmm.0.001257] [Citation(s) in RCA: 7] [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: 07/01/2020] [Accepted: 09/03/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction. Increasing levels of antibiotic resistance are complicating treatment for the sexually transmitted pathogen Mycoplasma genitalium. Resistance to fluoroquinolones is associated with mutations in the parC gene. Although the precise mutations conferring resistance are not fully understood, the single nucleotide polymorphism (SNP) G248T/S83I is most implicated.Aim. To evaluate the performance of the MG+parC(beta2) assay (SpeeDx, Australia), which detects single nucleotide polymorphisms (SNPs) in the parC gene at amino acid position S83 (A247C/S83R, G248T/S83I, G248A/S83N) and D87 (G259A/D87N, G259T/D87Y, G259C/D87H).Methods. Clinical samples were analysed by MG+parC(beta2) assay and results compared to Sanger sequencing. Sensitivity, specificity, and predictive value for treatment failure were calculated.Results. From analysis of 205 samples, the MG+parC(beta2) assay performed with a high sensitivity 98.2% (95% CI:90.3-100) and specificity 99.3% (95% CI:96.3-100) for parC SNP detection with a kappa of 0.97 (95% CI:0.94-1.00). The predictive value of G248T/S83I detection (the most common SNP, prevalence of 13% in the study population) was analysed with respect to treatment failure (patients received sequential doxycycline-moxifloxacin). The positive-predictive-value for moxifloxacin failure after detection of S83I was only 44% (95% CI:24.4-65.1), while negative-predictive-value was high at 96.9% (95% CI:92.7-99.0), suggesting that other SNPs are contributing to resistance.Conclusion. MG+parC(beta2) performed with high concordance compared to Sanger sequencing. Such qPCR assays can assist in understanding causes of treatment failure, inform the development of diagnostic assays, and can be applied to surveillance of mutations in populations. Due to an incomplete understanding of the basis for fluoroquinolone resistance, such tests do not appear to be ready for clinical application.
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Affiliation(s)
- Kaveesha Bodiyabadu
- SpeeDx, Sydney, NSW, Australia
- 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
| | - Jennifer Danielewski
- 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
| | - Suzanne M. Garland
- 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
- The Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
| | - 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, Sydney, NSW, Australia
| | - Catriona S. Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Joshua Birnie
- Molecular Microbiology Research Group, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | | | | | - Gerald Murray
- 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
- The Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
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Clinical evaluation of commercial PCR assays for antimicrobal resistance in Mycoplasma genitalium and estimation of resistance-mediated mutation prevalence in Moscow and Moscow region. Eur J Clin Microbiol Infect Dis 2021; 40:1413-1418. [PMID: 33515097 DOI: 10.1007/s10096-021-04170-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
Mycoplasma genitalium is a widespread sexually transmitted infection (STI) with growing rate of antimicrobials resistance. In our study, 137 vaginal and 131 urethral M. genitalium-positive swabs were sequentially collected through the work of Reference Center for STI during 2019. For prevalence evaluation of macrolide-resistance mutations three commercially available kits were used: AmpliSens® M. genitalium-ML/FQ-Resist-FL (Central Research Institute of Epidemiology, Russia), ResistancePlus® MG (SpeeDx, Australia), and S-DiaMGRes™ (Diagenode, Belgium). Macrolide resistance mutations were detected in 16% (43 of 268) of samples. Diagnostic characteristics were evaluated against Sanger sequencing. For AmpliSens® M. genitalium-ML/FQ-Resist-FL specificity was shown to be 100% (CI 95%, 98.4-100), and sensitivity was 90.7% (CI 95%, 77.9-97.4). ResistancePlus® MG specificity was 100% (CI 95%, 98.3-100), and sensitivity was 92.1% (CI 95%, 78.6-98.3). S-DiaMGRes™ specificity was shown to be 88.6% (CI 95%, 83.9-92.4), and sensitivity was 100% (CI 95%, 84.4-100). Mutations of parC gene region were detected in 14.5% (38 of 268) using AmpliSens® M. genitalium-ML/FQ-Resist-FL with further validation by Sanger sequencing. Of studied samples, 6.3% (17 of 268) contained both antimicrobials of class resistance mutations. Prevalence of macrolide-resistant M. genitalium in Moscow was 21.7% (23 of 106) and of fluoroquinolone-resistant M. genitaliuim was 20.8% (22 of 106). In Moscow region, macrolide-resistant M. genitalium were 12.3% (20 of 162) and 9.9% (16 of 162) of fluoroquinolone-resistant M. genitalium. All three kits can be used both for epidemiological monitoring of M. genitalium presence and mutation prevalence estimation. In Moscow, macrolide- and fluoroquinolone-resistant mutant prevalence increased in 3.9 and 2.7 times in 3 years.
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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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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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Shipitsyna E, Unemo M. A profile of the FDA-approved and CE/IVD-marked Aptima Mycoplasma genitalium assay (Hologic) and key priorities in the management of M. genitalium infections. Expert Rev Mol Diagn 2020; 20:1063-1074. [PMID: 33095669 DOI: 10.1080/14737159.2020.1842198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Mycoplasma genitalium (MG) causes frequently asymptomatic STIs. MG prevalence figures are lacking and management is complicated by the lack of etiological diagnostics and high antimicrobial resistance in many countries. Appropriately validated, quality-assured, and FDA-approved MG diagnostic assays have been lacking. AREAS COVERED The clinical and analytical performance characteristics of the Aptima® MG assay, the first FDA-approved MG nucleic acid amplification test (NAAT), are summarized. Key priorities in the management and control of MG infections are also discussed. EXPERT OPINION Highly sensitive, specific, and quality-assured MG NAATs, e.g. the Aptima MG assay on the automated and flexible Panther® platform, are imperative to improve the management and control of MG infections internationally. This testing, combined with macrolide-resistance testing (not yet available on the Panther platform), offers a rapid, high-throughput, and appropriate diagnosis of MG. Macrolide resistance-guided sequential treatment needs to be implemented for MG infections. Dual antimicrobial therapy, novel antimicrobials and, ideally, a vaccine may become essential.
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Affiliation(s)
- Elena Shipitsyna
- Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , St. Petersburg, Russia
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
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Pitt R, Unemo M, Sonnenberg P, Alexander S, Beddows S, Cole MJ, Clifton S, Mercer CH, Johnson AM, Ison CA, Field N. Antimicrobial resistance in Mycoplasma genitalium sampled from the British general population. Sex Transm Infect 2020; 96:464-468. [PMID: 31924741 PMCID: PMC7476295 DOI: 10.1136/sextrans-2019-054129] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/20/2019] [Accepted: 12/12/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium is a common sexually transmitted infection. Treatment guidelines focus on those with symptoms and sexual contacts, generally with regimens including doxycycline and/or azithromycin as first-line and moxifloxacin as second-line treatment. We investigated the prevalence of antimicrobial resistance (AMR)-conferring mutations in M. genitalium among the sexually-active British general population. METHODS The third national survey of sexual attitudes and lifestyles (Natsal-3) is a probability sample survey of 15 162 men and women aged 16-74 years in Britain conducted during 2010-12. Urine test results for M. genitalium were available for 4507 participants aged 16-44 years reporting >1 lifetime sexual partner. In this study, we sequenced regions of the 23S rRNA and parC genes to detect known genotypic determinants for resistance to macrolides and fluoroquinolones respectively. RESULTS 94% (66/70) of specimens were re-confirmed as M. genitalium positive, with successful sequencing in 85% (56/66) for 23S rRNA and 92% (61/66) for parC genes. Mutations in 23S rRNA gene (position A2058/A2059) were detected in 16.1% (95%CI: 8.6% to 27.8%) and in parC (encoding ParC D87N/D87Y) in 3.3% (0.9%-11.2%). Macrolide resistance was more likely in participants reporting STI diagnoses (past 5 years) (44.4% (18.9%-73.3%) vs 10.6% (4.6%-22.6%); p=0.029) or sexual health clinic attendance (past year) (43.8% (23.1%-66.8%) vs 5.0% (1.4%-16.5%); p=0.001). All 11 participants with AMR-conferring mutations had attended sexual health clinics (past 5 years), but none reported recent symptoms. CONCLUSIONS This study highlights challenges in M. genitalium management and control. Macrolide resistance was present in one in six specimens from the general population in 2010-2012, but no participants with AMR M. genitalium reported symptoms. Given anticipated increases in diagnostic testing, new strategies including novel antimicrobials, AMR-guided therapy, and surveillance of AMR and treatment failure are recommended.
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Affiliation(s)
- Rachel Pitt
- National Infection Service, Public Health England, London, United Kingdom
| | - 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, Orebro, Sweden
| | - Pam Sonnenberg
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, UCL, London, United Kingdom
| | - Sarah Alexander
- National Infection Service, Public Health England, London, United Kingdom
| | - Simon Beddows
- National Infection Service, Public Health England, London, United Kingdom
| | | | - Soazig Clifton
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, UCL, London, United Kingdom
| | - Catherine H Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, UCL, London, United Kingdom
| | - Anne M Johnson
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, UCL, London, United Kingdom
| | - Catherine A Ison
- National Infection Service, Public Health England, London, United Kingdom
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, UCL, London, United Kingdom
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21
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Yang L, Ke W. Azithromycin, minocycline, moxifloxacin and spectinomycin failure in a case with persistent Mycoplasma genitalium infection in Guangzhou, China. Int J STD AIDS 2020; 31:1106-1109. [PMID: 32842908 DOI: 10.1177/0956462420905269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of Mycoplasma genitalium-positive non-gonococcal urethritis who failed to respond to multiple different courses of antibiotics including azithromycin, minocycline, moxifloxacin and spectinomycin. Extracted M. genitalium DNA from urethral swabs obtained from the patient harbored mutations of 23S rRNA, parC and gyrA. Microbiological cure was eventually achieved by a 14-day course of doxycycline.
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Affiliation(s)
- Ligang Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Wujian Ke
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, China
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22
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Quinolone Resistance-Associated Mutations in Mycoplasma genitalium: Not Ready for Prime Time. Sex Transm Dis 2020; 47:199-201. [PMID: 32032318 DOI: 10.1097/olq.0000000000001132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Chambers LC, Jensen JS, Morgan JL, Lowens MS, Romano SS, Totten PA, Soge OO, Hughes JP, Golden MR, Manhart LE. Lack of Association Between the S83I ParC Mutation in Mycoplasma genitalium and Treatment Outcomes Among Men Who Have Sex With Men with Nongonococcal Urethritis. Sex Transm Dis 2020; 46:805-809. [PMID: 31259853 DOI: 10.1097/olq.0000000000001035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
From February 2015 to October 2017, among 20 men who have sex with men with Mycoplasma genitalium-associated nongonococcal urethritis, 15% had macrolide resistance and S83I ParC mutations. Azithromycin followed by moxifloxacin cleared Mycoplasma genitalium in 2 of 2 with and 11 of 13 without S83I mutations. Dual failures were cleared after doxycycline. S83I mutations were not associated with moxifloxacin failure.
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Affiliation(s)
- Laura C Chambers
- From the Department of Epidemiology, University of Washington, Seattle, WA
| | | | | | | | - Sarah S Romano
- From the Department of Epidemiology, University of Washington, Seattle, WA
| | | | | | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Matthew R Golden
- From the Department of Epidemiology, University of Washington, Seattle, WA.,HIV/STD Program, Public Health-Seattle and King County.,Department of Medicine
| | - Lisa E Manhart
- From the Department of Epidemiology, University of Washington, Seattle, WA.,Department of Global Health
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24
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Resolution of Symptoms and Resumption of Sex After Diagnosis of Nongonococcal Urethritis Among Men Who Have Sex With Men. Sex Transm Dis 2020; 46:676-682. [PMID: 31356530 DOI: 10.1097/olq.0000000000001040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Standard counseling at nongonococcal urethritis (NGU) diagnosis includes advice to abstain from sex for at least 7 days and until symptoms resolve. METHODS From December 2014 to July 2018, we enrolled men who have sex with men and received azithromycin (1 g) for NGU at the Public Health-Seattle and King County STD Clinic. Over 12 weeks of follow-up, participants reported daily urethral symptoms and sexual activity on web-based diaries. Nongonococcal urethritis was defined as urethral symptoms or visible urethral discharge plus 5 or greater polymorphonuclear leukocytes per high-power field. Time of symptom resolution was defined as the first of 5 consecutive asymptomatic days. RESULTS Of 100 participants with NGU and no Chlamydia trachomatis (CT)/Mycoplasma genitalium (MG) coinfection, 36 (36%), 22 (22%), and 42 (42%) had CT-NGU, MG-NGU, and non-CT/non-MG NGU, respectively. Among men with MG-NGU, 94% had a macrolide resistance mutation. For all etiologies, median time to symptom resolution after azithromycin was 7 days (95% confidence interval [CI], 5-9); 37% had symptoms lasting longer than 7 days. For men with CT-NGU, MG-NGU, and non-CT/non-MG NGU, median time to symptom resolution was 4 days (95% CI, 2-6; 16% >7 days), undefined days (95% CI, 7 to undefined; 60% >7 days), and 7 days (95% CI, 5-11; 46% >7 days), respectively. Median time to first sexual activity (any type) was 12 days (95% CI, 11-17); it was 16 days (95% CI, 12-18) to first urethral sexual exposure. Twenty-seven percent did not avoid urethral exposure for the recommended period. CONCLUSIONS Counseling at NGU diagnosis should educate patients that symptoms may persist more than 7 days, particularly for non-CT NGU, and emphasize the rationale for the 7-day abstinence period.
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25
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Prevalence, Macrolide Resistance, and Fluoroquinolone Resistance in Mycoplasma genitalium in Men Who Have Sex With Men Attending an Sexually Transmitted Disease Clinic in Dublin, Ireland in 2017-2018. Sex Transm Dis 2020; 46:e35-e37. [PMID: 30676483 DOI: 10.1097/olq.0000000000000940] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This is the first prevalence study of Mycoplasma genitalium and antimicrobial resistance study in Ireland. In urine samples from men who have sex with men (n = 400) attending a sexually transmitted disease clinic in Dublin, the prevalence of M. genitalium was 3% (12 of 400 specimens; 95% confidence interval, 1.3-4.7%), and the prevalences of macrolide resistance (75%), fluoroquinolone resistance (33.3%), and multidrug resistance (33.3%) were very high.
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26
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Fernández-Huerta M, Vall M, Fernández-Naval C, Barberá MJ, Arando M, López L, Andreu A, Pumarola T, Serra-Pladevall J, Esperalba J, Espasa M. Mycoplasma genitalium macrolide resistance update: Rate among a 2016–2017 cohort of patients in Barcelona, Spain. Enferm Infecc Microbiol Clin 2020; 38:99-104. [DOI: 10.1016/j.eimc.2019.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
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27
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Multicenter Clinical Evaluation of a Novel Multiplex Real-Time PCR (qPCR) Assay for Detection of Fluoroquinolone Resistance in Mycoplasma genitalium. J Clin Microbiol 2019; 57:JCM.00886-19. [PMID: 31434719 PMCID: PMC6812999 DOI: 10.1128/jcm.00886-19] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma genitalium causes a common sexually transmitted infection with a marked propensity to develop antimicrobial resistance. As few treatment options exist, this poses significant challenges to clinicians. Recent diagnostic advances have resulted in tests that report the simultaneous detection of M. genitalium and any resistance to macrolides, the first-line treatment. This allows for therapy to be tailored to the individual, thereby optimizing treatment outcomes. Mycoplasma genitalium causes a common sexually transmitted infection with a marked propensity to develop antimicrobial resistance. As few treatment options exist, this poses significant challenges to clinicians. Recent diagnostic advances have resulted in tests that report the simultaneous detection of M. genitalium and any resistance to macrolides, the first-line treatment. This allows for therapy to be tailored to the individual, thereby optimizing treatment outcomes. However, resistance to fluoroquinolones, the second-line treatment, is increasing in M. genitalium. In this study, we describe a new assay, MG+parC (beta), which simultaneously reports the detection of M. genitalium and five parC mutations that have been associated with resistance to fluoroquinolones. These mutations affect the amino acid sequence of ParC at residues S83R (A247C), S83I (G248T), D87N (G259A), D87Y (G259T), and D87H (G259C). The study tested the MG+parC (beta) assay with 202 M. genitalium-positive clinical samples from Australia (n = 141) and Spain (n = 61). Compared to Sanger sequencing, the assay performed with a kappa value of 0.985 (95% confidence interval [CI], 0.955 to 1.000), with a mutation detection sensitivity of 97.6% (95% CI, 87.4 to 99.9), and specificity of 100.0% (95% CI, 97.7 to 100.0). Fluoroquinolone resistance-associated mutations in parC targeted by the assay were more prevalent among the Australian cohort (23.4% [95% CI,16.3 to 31.8]) compared to the Spanish population (8.8% [95% CI, 2.9% to 19.3%]) (P = 0.019). The MG+parC (beta) kit is a simple and reliable method for simultaneous detection of M. genitalium and fluoroquinolone resistance-associated mutations in clinical settings. This novel diagnostic tool may extend the utility of the second line of antimicrobial therapies in M. genitalium infection.
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28
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Romano SS, Jensen JS, Lowens MS, Morgan JL, Chambers LC, Robinson TS, Totten PA, Soge OO, Golden MR, Manhart LE. Long Duration of Asymptomatic Mycoplasma genitalium Infection After Syndromic Treatment for Nongonococcal Urethritis. Clin Infect Dis 2019; 69:113-120. [PMID: 30281079 PMCID: PMC6579957 DOI: 10.1093/cid/ciy843] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/28/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although Mycoplasma genitalium (MG) is an acknowledged cause of nongonococcal urethritis (NGU), access to diagnostic testing is limited. Syndromic management is common, yet little is known about natural history. METHODS Between August 2014 and April 2016, 13 heterosexual men aged ≥16 years with MG were identified within a cohort study of men with and without NGU attending an urban sexually transmitted diseases clinic. Men had 6-7 monthly visits. NGU was defined as ≥5 polymorphonuclear leukocytes per high-power field on urethral Gram stain plus either visible urethral discharge or urethral symptoms. Men with NGU received 1 g of azithromycin. Men with persistent NGU received moxifloxacin 400 mg for 14 days. First-void urine was retrospectively tested for MG using transcription-mediated amplification. Resistance-associated mutations were detected by polymerase chain reaction (PCR) and sequencing. Organism load was determined by quantitative PCR. RESULTS Sixty-two percent of MG-positive men had macrolide resistance-mediating mutations (MRMM) at enrollment; 31% had parC mutations (all outside the quinolone resistance-determining region). MG persisted after azithromycin in 7 men, 6 of whom had MRMM. The median duration of persistence in the absence of curative therapy was 143 days (range, 21-228). Five men experienced symptom resolution after azithromycin, but MG persisted for another 89-186 days before moxifloxacin. Organism load was somewhat lower in MRMM than wild-type infections (P = .16). CONCLUSIONS The high prevalence of macrolide resistance and long duration of infection after symptom resolution highlights the need for diagnostic MG testing of men with NGU to direct therapy.
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Affiliation(s)
- Sarah S Romano
- Department of Epidemiology, University of Washington, Seattle
- Center for AIDS and STD, University of Washington, Seattle
| | | | - M Sylvan Lowens
- Public Health–Seattle & King County, University of Washington, Seattle
| | - Jennifer L Morgan
- Public Health–Seattle & King County, University of Washington, Seattle
| | - Laura C Chambers
- Department of Epidemiology, University of Washington, Seattle
- Center for AIDS and STD, University of Washington, Seattle
| | - Tashina S Robinson
- Department of Epidemiology, University of Washington, Seattle
- Center for AIDS and STD, University of Washington, Seattle
| | - Patricia A Totten
- Center for AIDS and STD, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
| | - Olusegun O Soge
- Center for AIDS and STD, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle
- Center for AIDS and STD, University of Washington, Seattle
- Public Health–Seattle & King County, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle
- Center for AIDS and STD, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
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29
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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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30
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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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31
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Unemo M, Salado-Rasmussen K, Hansen M, Olsen A, Falk M, Golparian D, Aasterød M, Ringlander J, Nilsson CS, Sundqvist M, Schønning K, Moi H, Westh H, Jensen J. Clinical and analytical evaluation of the new Aptima Mycoplasma genitalium assay, with data on M. genitalium prevalence and antimicrobial resistance in M. genitalium in Denmark, Norway and Sweden in 2016. Clin Microbiol Infect 2018; 24:533-539. [DOI: 10.1016/j.cmi.2017.09.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 11/26/2022]
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32
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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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33
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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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34
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Mycoplasma genitalium Macrolide and Fluoroquinolone Resistance: Prevalence and Risk Factors Among a 2013–2014 Cohort of Patients in Barcelona, Spain. Sex Transm Dis 2017; 44:457-462. [DOI: 10.1097/olq.0000000000000631] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Murray GL, Bradshaw CS, Bissessor M, Danielewski J, Garland SM, Jensen JS, Fairley CK, Tabrizi SN. Increasing Macrolide and Fluoroquinolone Resistance in Mycoplasma genitalium. Emerg Infect Dis 2017; 23:809-812. [PMID: 28418319 PMCID: PMC5403035 DOI: 10.3201/eid2305.161745] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Escalating resistance to azithromycin and moxifloxacin is being reported for Mycoplasma genitalium in the Asia-Pacific region. Analyzing 140 infections, we found pretreatment fluoroquinolone-resistance mutations in parC (13.6%) and gyrA (5%). ParC S83 changes were associated with moxifloxacin failure. Combined macrolide/fluoroquinolone-resistance mutations were in 8.6% of specimens, for which recommended therapies would be ineffective.
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36
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Shipitsyna E, Rumyantseva T, Golparian D, Khayrullina G, Lagos AC, Edelstein I, Joers K, Jensen JS, Savicheva A, Rudneva N, Sukhanova L, Kozlov R, Guschin A, Unemo M. Prevalence of macrolide and fluoroquinolone resistance-mediating mutations in Mycoplasma genitalium in five cities in Russia and Estonia. PLoS One 2017; 12:e0175763. [PMID: 28407014 PMCID: PMC5391023 DOI: 10.1371/journal.pone.0175763] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/30/2017] [Indexed: 11/18/2022] Open
Abstract
Background and objective Resistance in the sexually transmitted bacterium Mycoplasma genitalium to all recommended therapeutic antimicrobials have rapidly emerged. However, to date, internationally reported resistance surveillance data for M. genitalium strains circulating in Eastern Europe are entirely lacking. The aim of this study was to estimate the prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium in four cities in Russia and one in Estonia, 2013–2016. Materials and methods Consecutive urogenital samples found positive for M. genitalium during diagnostic testing were retrospectively analyzed for resistance-associated mutations in the 23S rRNA and parC genes using pyrosequencing and conventional Sanger sequencing, respectively. Results In total, 867 M. genitalium positive samples from 2013–2016 were analyzed. Macrolide resistance-associated mutations were detected in 4.6% of the samples from Russia (0.7–6.8% in different cities) and in 10% of the samples from Estonia. The mutations A2059G and A2058G were highly predominating in both Russia and Estonia, accounting together for 90.9% of the cases positive for nucleotide substitutions in the 23S rRNA gene. The rates of possible fluoroquinolone resistance-associated mutations were 6.2% in Russia (2.5–7.6% in different cities) and 5% in Estonia. The mutations S83I and S83N were the most frequent ones in Russia (24.4% each), whereas D87N highly predominated in Estonia (83.3% of all fluoroquinolone resistance-associated mutations). Approximately 1% of the samples in both countries harbored both macrolide and possible fluoroquinolone resistance-associated mutations, with A2058G and S83I being the most frequent combination (37.5%). Conclusions The prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium was 4.6% and 6.2%, respectively, in Russia, and 10% and 5%, respectively, in Estonia. Despite the relatively low rates of macrolide and fluoroquinolone resistance in these countries, antimicrobial resistance surveillance and testing for resistance-associated mutations in M. genitalium positive cases would be valuable.
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Affiliation(s)
- Elena Shipitsyna
- Laboratory of Microbiology, D.O. Ott Research Institute of Obstetrics, Gynaecology and Reproductology, St. Petersburg, Russia
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tatiana Rumyantseva
- Laboratory of Molecular Diagnostics, Central Research Institute of Epidemiology, Moscow, Russia
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Guzel Khayrullina
- Laboratory of Molecular Diagnostics, Central Research Institute of Epidemiology, Moscow, Russia
| | - Amaya C. Lagos
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Inna Edelstein
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, Smolensk, Russia
| | - Kai Joers
- United Laboratories, Tartu University Hospital, Tartu, Estonia
| | - Jörgen S. Jensen
- Department of Microbiology and Infection Control, Sexually Transmitted Infections, Research and Development, Statens Serum Institut, Copenhagen, Denmark
| | - Alevtina Savicheva
- Laboratory of Microbiology, D.O. Ott Research Institute of Obstetrics, Gynaecology and Reproductology, St. Petersburg, Russia
| | - Natalia Rudneva
- Tula Regional Clinic of Dermato-Venereology of the Ministry of Health of the Tula Region, Tula, Russia
| | - Larisa Sukhanova
- Tula Regional Clinic of Dermato-Venereology of the Ministry of Health of the Tula Region, Tula, Russia
| | - Roman Kozlov
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, Smolensk, Russia
| | - Alexander Guschin
- Laboratory of Molecular Diagnostics, Central Research Institute of Epidemiology, Moscow, Russia
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- * E-mail:
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Unemo M, Jensen JS. Antimicrobial-resistant sexually transmitted infections: gonorrhoea and Mycoplasma genitalium. Nat Rev Urol 2017; 14:139-152. [PMID: 28072403 DOI: 10.1038/nrurol.2016.268] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The emergence of antimicrobial resistance (AMR) is a major concern worldwide and already compromises treatment effectiveness and control of several bacterial sexually transmitted infections (STIs). Neisseria gonorrhoeae and Mycoplasma genitalium are evolving into so-called superbugs that can become resistant, both in vitro and clinically, to essentially all antimicrobials available for treatment, causing exceedingly difficult-to-treat or untreatable STIs and threatening global public health. Widespread AMR in these bacteria is likely to persist and even worsen in the future, owing to the high number of infections, widespread and uncontrolled use of antimicrobials, limited surveillance of AMR and clinical failures, as well as the extraordinary capacity of these bacteria to develop AMR. This development would not only result in an increased prevalence of N. gonorrhoeae and M. genitalium infections but also in a considerably increasing number of severe complications affecting reproductive health. To combat this threat, clinicians need to be aware of the current guidelines on diagnostic procedures, recommended treatment regimens, as well as therapeutic options for multidrug-resistant bacteria. AMR testing needs to be more frequently performed, inform treatment decisions and elucidate how AMRs compromise treatment effectiveness, guiding research for effective future therapies.
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Affiliation(s)
- Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, SE-701 85 Örebro, Sweden
| | - Jorgen S Jensen
- Department of Microbiology and Infection Control, Sexually Transmitted Infections, Research and Development, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
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Jensen JS, Cusini M, Gomberg M, Moi H. Background review for the 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol 2016; 30:1686-1693. [PMID: 27605499 DOI: 10.1111/jdv.13850] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/23/2016] [Indexed: 11/29/2022]
Abstract
Mycoplasma genitalium is a cause of 10-35% of non-chlamydial non-gonococcal urethritis in men and in women, and is associated with cervicitis and pelvic inflammatory disease (PID). Transmission of M. genitalium occurs through direct mucosal contact. In women, symptoms include vaginal discharge, dysuria or symptoms of PID - abdominal pain and dyspareunia. In men, urethritis, dysuria and discharge predominates. Asymptomatic infections are frequent. In this review, we present the evidence base for the recommendations in the 2016 European guideline on M. genitalium infections and describe indications for testing, recommended diagnostic methods, treatment and patient management. The guideline was prepared on behalf of the European branch of The International Union against Sexually Transmitted Infections; the European Academy of Dermatology and Venereology; the European Dermatology Forum; the European Society of Clinical Microbiology and Infectious Diseases; the Union of European Medical Specialists. The European Centre for Disease Prevention and Control and the European Office of the World Health Organisation also contributed to their development.
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Affiliation(s)
- J S Jensen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
| | - M Cusini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Gomberg
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
| | - H Moi
- Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Oslo, Norway
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Deguchi T, Kikuchi M, Yasuda M, Ito S. Multidrug-ResistantMycoplasma genitaliumIs Increasing: Table 1. Clin Infect Dis 2015; 62:405-6. [DOI: 10.1093/cid/civ898] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Jensen JS, Bradshaw C. Management of Mycoplasma genitalium infections - can we hit a moving target? BMC Infect Dis 2015; 15:343. [PMID: 26286546 PMCID: PMC4545773 DOI: 10.1186/s12879-015-1041-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/20/2015] [Indexed: 11/10/2022] Open
Abstract
Mycoplasma genitalium is an etiological agent of sexually transmitted infections, but due to its fastidious growth requirements, only a few M. genitalium strains are available for determination of the activity of currently used and new antimicrobial agents. Recent clinical trials have demonstrated that treatment with azithromycin has decreasing efficacy due to an increasing prevalence of macrolide resistance, which is likely to be attributed to the widespread use of 1 g single dose azithromycin. Second line treatment with moxifloxacin is similarly under pressure from emerging resistance. The era of single dose monotherapy for uncomplicated STIs such as M. genitalium and N. gonorrhoeae, while convenient for patients and physicians, has been associated with escalating resistance and treatment failure and is now drawing to a close. There is a critical need for trials of combinations of existing registered drugs and new antimicrobial compounds, implementation of diagnostic testing combined with molecular detection of resistance, and antimicrobial surveillance.
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Affiliation(s)
- Jørgen Skov Jensen
- Microbiology and Infection Control, Sexually Transmitted Bacterial Infections, Research and Development, Statens Serum Institut, Artillerivej 5, Copenhagen, DK-2300, Denmark.
| | - Catriona Bradshaw
- Central Clinical School. Monash University, Melbourne, VIC, Australia. .,Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, VIC, Australia.
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Bissessor M, Tabrizi SN, Twin J, Abdo H, Fairley CK, Chen MY, Vodstrcil LA, Jensen JS, Hocking JS, Garland SM, Bradshaw CS. Macrolide resistance and azithromycin failure in a Mycoplasma genitalium-infected cohort and response of azithromycin failures to alternative antibiotic regimens. Clin Infect Dis 2014; 60:1228-36. [PMID: 25537875 DOI: 10.1093/cid/ciu1162] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Our aim was to determine the efficacy of 1 g azithromycin and alternative antibiotic regimens in a prospective cohort of Mycoplasma genitalium-infected participants, and factors associated with azithromycin failure. METHODS Consecutive eligible M. genitalium-infected men and women attending the Melbourne Sexual Health Centre between July 2012 and June 2013 were treated with 1 g of azithromycin and retested by polymerase chain reaction (PCR) on days 14 and 28. Cure was defined as PCR negative on day 28. Cases failing azithromycin were treated with moxifloxacin, and those failing moxifloxacin were treated with pristinamycin. Pre- and posttreatment samples were assessed for macrolide resistance mutations (MRMs) by high-resolution melt analysis. Mycoplasma genitalium samples from cases failing moxifloxacin were sequenced for fluoroquinolone resistance mutations. Multivariable analysis was used to examine associations with azithromycin failure. RESULTS Of 155 participants treated with 1 g azithromycin, 95 (61% [95% confidence interval {CI}, 53%-69%]) were cured. Pretreatment MRM was detected in 56 (36% [95% CI, 28%-43%]) participants, and strongly associated with treatment failure (87% [95% CI, 76%-94%]; adjusted odds ratio, 47.0 [95% CI, 17.1-129.0]). All 11 participants who had MRM detected in posttreatment samples failed azithromycin. Moxifloxacin was effective in 53(88% [95% CI, 78%-94%]) of 60 cases failing azithromycin; all failures had gyrA and parC mutations detected in pretreatment samples. Six of 7 patients failing moxifloxacin treatment received pristinamycin, and all were PCR negative 28 days after pristinamycin treatment. CONCLUSIONS We report a high azithromycin failure rate (39%) in an M. genitalium-infected cohort in association with high levels of pretreatment macrolide resistance. Moxifloxacin failure occurred in 12% of patients who received moxifloxacin; all had pretreatment fluoroquinolone mutations detected. Pristinamycin was highly effective in treating macrolide- and quinolone-resistant strains.
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Affiliation(s)
- Melanie Bissessor
- Melbourne Sexual Health Centre, Alfred Hospital Melbourne School of Population and Global Health
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynaecology, University of Melbourne Department of Microbiology, Infectious Diseases, The Royal Women's Hospital, Murdoch Childrens Research Institute
| | - Jimmy Twin
- Department of Microbiology, Infectious Diseases, The Royal Women's Hospital, Murdoch Childrens Research Institute
| | - Houda Abdo
- Department of Microbiology, Infectious Diseases, The Royal Women's Hospital, Murdoch Childrens Research Institute
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Hospital Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Hospital Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Hospital Melbourne School of Population and Global Health Department of Microbiology, Infectious Diseases, The Royal Women's Hospital, Murdoch Childrens Research Institute
| | | | | | | | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Hospital Melbourne School of Population and Global Health Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Sitafloxacin: antimicrobial activity against ciprofloxacin-selected laboratory mutants of Mycoplasma genitalium and inhibitory activity against its DNA gyrase and topoisomerase IV. J Infect Chemother 2014; 21:74-5. [PMID: 25245990 DOI: 10.1016/j.jiac.2014.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/19/2014] [Indexed: 11/23/2022]
Abstract
A sitafloxacin regimen is highly effective on Mycoplasma genitalium infections, including those caused by the mycoplasmas harboring mutant topoisomerase IV with a quinolone resistance-associated amino acid change in ParC. In this study, we evaluated sitafloxacin antimicrobial activities against M. genitalium, including the mycoplasmas with decreased susceptibilities to quinolones, by determining minimum inhibitory concentrations (MICs) for the strain ATCC 33530 and its 3 ciprofloxacin-selected mutants, for which ciprofloxacin MICs were 8-16 times higher than that for their parent strain. We also evaluated inhibitory activities against the target enzymes of M. genitalium by determining concentrations required to inhibit 50% (IC50) of the supercoiling activity of the recombinant wild-type DNA gyrase and the decatenating activities of the recombinant wild-type topoisomerase IV and the 2 types of mutant topoisomerase IV with a single amino acid change in ParC. Sitafloxacin MICs were 0.125 for the parent strain and 0.125-0.25 μg/ml for the mutants. Sitafloxacin IC50s were 3.12 for the supercoiling activity of the wild-type DNA gyrase and 2.98 μg/ml for the decatenating activity of the wild-type topoisomerase IV. Its IC50s for the decatenating activity of the mutant topoisomerase IV harboring an amino acid change in ParC were 15.1 for Gly-81 → Cys and 7.92 μg/ml for Asp-87 → Tyr. Sitafloxacin was highly active against ciprofloxacin-selected mutants of M. genitalium and possessed intense inhibitory activities not only against wild-type DNA gyrase and topoisomerase IV but also against mutant topoisomerase IV containing ParC with a quinolone resistance-associated amino acid change. Sitafloxacin could be a promising agent for M. genitalium infections.
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Kikuchi M, Ito S, Yasuda M, Tsuchiya T, Hatazaki K, Takanashi M, Ezaki T, Deguchi T. Remarkable increase in fluoroquinolone-resistant Mycoplasma genitalium in Japan. J Antimicrob Chemother 2014; 69:2376-82. [PMID: 24894419 DOI: 10.1093/jac/dku164] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We determined the prevalence of macrolide and fluoroquinolone resistance-associated mutations in Mycoplasma genitalium DNA specimens from men with non-gonococcal urethritis (NGU) and analysed their effects on antibiotic treatments of M. genitalium infections. METHODS In this retrospective study, we examined antibiotic resistance-associated mutations in the 23S rRNA, gyrA and parC genes of M. genitalium and the association of the mutations with microbiological outcomes of antibiotic treatments in men with M. genitalium-positive NGU. RESULTS No macrolide resistance-associated mutations in the 23S rRNA gene were observed in 27 M. genitalium DNA specimens in 2011 and in 24 in 2012. However, 5 of 17 in 2013 had 23S rRNA mutations. Three of 15 in 2011, 6 of 19 in 2012 and 8 of 17 in 2013 had fluoroquinolone resistance-associated alterations in ParC. Three in 2013 had both the antibiotic resistance-associated alterations coincidentally. In two men with M. genitalium harbouring 23S rRNA mutations, the mycoplasma persisted after treatment with a regimen of 2 g of extended-release azithromycin (AZM-SR) once daily for 1 day. All nine men with mycoplasma harbouring ParC alterations were microbiologically cured with a regimen of 100 mg of sitafloxacin twice daily for 7 days. CONCLUSIONS Macrolide- or fluoroquinolone-resistant M. genitalium appears to be increasing, and the increase in fluoroquinolone-resistant mycoplasmas is especially remarkable in Japan. Mycoplasmas harbouring 23S rRNA mutations would be resistant to the AZM-SR regimen, but those harbouring ParC alterations would still be susceptible to the sitafloxacin regimen.
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Affiliation(s)
- Mina Kikuchi
- Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | | | - Mitsuru Yasuda
- Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Tomohiro Tsuchiya
- Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Kyoko Hatazaki
- Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Masaki Takanashi
- Infectious Disease Testing Department, Mitsubishi Chemical Medience Corporation, Tokyo, Japan
| | - Takayuki Ezaki
- Department of Microbiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Takashi Deguchi
- Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan
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Ito S, Mizutani K, Seike K, Sugawara T, Tsuchiya T, Yasuda M, Yokoi S, Nakano M, Deguchi T. Prediction of the persistence of Mycoplasma genitalium after antimicrobial chemotherapy by quantification of leukocytes in first-void urine from patients with non-gonococcal urethritis. J Infect Chemother 2014; 20:298-302. [DOI: 10.1016/j.jiac.2014.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/01/2013] [Accepted: 01/09/2014] [Indexed: 11/26/2022]
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Deguchi T, Ito S, Hagiwara N, Yasuda M, Maeda SI. Antimicrobial chemotherapy ofMycoplasma genitalium-positive non-gonococcal urethritis. Expert Rev Anti Infect Ther 2014; 10:791-803. [DOI: 10.1586/eri.12.38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hamasuna R. Mycoplasma genitaliumin male urethritis: Diagnosis and treatment in Japan. Int J Urol 2013; 20:676-84. [DOI: 10.1111/iju.12152] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 03/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Ryoichi Hamasuna
- Department of Urology; University of Occupational and Environmental Health; Kitakyushu; Japan
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Contribution of topoisomerase IV mutation to quinolone resistance in Mycoplasma genitalium. Antimicrob Agents Chemother 2013; 57:1772-6. [PMID: 23357772 DOI: 10.1128/aac.01956-12] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The mechanism of quinolone resistance in Mycoplasma genitalium remains poorly understood due to difficulties with in vitro culture, especially of clinical isolates. In this study, to confirm the association between mutations in topoisomerases and antimicrobial susceptibilities to quinolones, ciprofloxacin-resistant mutant strains were selected using the cultivable type strain ATCC 33530. Sequence analysis revealed that the mutant strains harbored mutations in topoisomerase IV: Gly81Cys in ParC, Pro261Thr in ParC, or Asn466Lys in ParE. The MICs of all quinolones tested against the mutant strains were 2- to 16-fold higher than those against the wild-type strain. No cross-resistance was observed with macrolides or tetracyclines. We determined the inhibitory activities of quinolones against DNA gyrase and topoisomerase IV in order to investigate the correlation between antimicrobial susceptibility and inhibitory activity against the target enzymes, considered the primary targets of quinolones. Furthermore, using enzymatic analysis, we confirmed that Gly81Cys in the ParC quinolone resistance-determining region (QRDR) contributed to quinolone resistance. This is the first study to isolate quinolone-resistant mutant strains of M. genitalium harboring substitutions in the parC or parE gene in vitro and to measure the inhibitory activities against the purified topoisomerases of M. genitalium.
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Hamasuna R. Identification of treatment strategies for Mycoplasma genitalium-related urethritis in male patients by culturing and antimicrobial susceptibility testing. J Infect Chemother 2012; 19:1-11. [PMID: 23076335 DOI: 10.1007/s10156-012-0487-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Indexed: 11/25/2022]
Abstract
Mycoplasma genitalium was first isolated from urethral swab specimens of male patients with non-gonococcal urethritis. However, the isolation of M. genitalium strains from clinical specimens has been difficult. Co-cultivation with Vero cells is one available technique for the isolation of M. genitalium. The strains that can be used for antimicrobial susceptibility testing by broth dilution or agar dilution methods are limited. Macrolides, such as azithromycin (AZM), have the strongest activity against M. genitalium. However, AZM-resistant strains have emerged and spread. Mutations in the 23S rRNA gene contribute to the organism's macrolide resistance, which is similar to the effects of the mutations in macrolide-resistant Mycoplasma pneumoniae. Of the fluoroquinolones, moxifloxacin (MFLX) and sitafloxacin have the strongest activities against M. genitalium, while levofloxacin and ciprofloxacin are not as effective. Some clinical trials on the treatment of M. genitalium-related urethritis are available in the literature. A doxycycline regimen was microbiologically inferior to an AZM regimen. For cases of treatment failure with AZM regimens, MFLX regimens were effective.
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Affiliation(s)
- Ryoichi Hamasuna
- Department of Urology, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
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Dalhoff A. Global fluoroquinolone resistance epidemiology and implictions for clinical use. Interdiscip Perspect Infect Dis 2012; 2012:976273. [PMID: 23097666 PMCID: PMC3477668 DOI: 10.1155/2012/976273] [Citation(s) in RCA: 212] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 06/26/2012] [Indexed: 12/22/2022] Open
Abstract
This paper on the fluoroquinolone resistance epidemiology stratifies the data according to the different prescription patterns by either primary or tertiary caregivers and by indication. Global surveillance studies demonstrate that fluoroquinolone resistance rates increased in the past years in almost all bacterial species except S. pneumoniae and H. influenzae, causing community-acquired respiratory tract infections. However, 10 to 30% of these isolates harbored first-step mutations conferring low level fluoroquinolone resistance. Fluoroquinolone resistance increased in Enterobacteriaceae causing community acquired or healthcare associated urinary tract infections and intraabdominal infections, exceeding 50% in some parts of the world, particularly in Asia. One to two-thirds of Enterobacteriaceae producing extended spectrum β-lactamases were fluoroquinolone resistant too. Furthermore, fluoroquinolones select for methicillin resistance in Staphylococci. Neisseria gonorrhoeae acquired fluoroquinolone resistance rapidly; actual resistance rates are highly variable and can be as high as almost 100%, particularly in Asia, whereas resistance rates in Europe and North America range from <10% in rural areas to >30% in established sexual networks. In general, the continued increase in fluoroquinolone resistance affects patient management and necessitates changes in some guidelines, for example, treatment of urinary tract, intra-abdominal, skin and skin structure infections, and traveller's diarrhea, or even precludes the use in indications like sexually transmitted diseases and enteric fever.
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Affiliation(s)
- Axel Dalhoff
- Institute for Infection-Medicine, Christian-Albrechts Univerity of Kiel and University Medical Center Schleswig-Holstein, Brunswiker Straße 4, 24105 Kiel, Germany
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Ito S, Yasuda M, Seike K, Sugawara T, Tsuchiya T, Yokoi S, Nakano M, Deguchi T. Clinical and microbiological outcomes in treatment of men with non-gonococcal urethritis with a 100-mg twice-daily dose regimen of sitafloxacin. J Infect Chemother 2012; 18:414-8. [PMID: 22370921 DOI: 10.1007/s10156-012-0392-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 02/08/2012] [Indexed: 12/13/2022]
Abstract
Several microorganisms cause non-gonococcal urethritis (NGU). Failure to eradicate Mycoplasma genitalium from the urethra could be associated with persistent or recurrent urethritis; thus, the choice of antibiotics with activities potent enough to eradicate M. genitalium is crucial in the treatment of NGU. In in vitro studies, sitafloxacin has been shown to be highly active against Chlamydia trachomatis and M. genitalium. We treated 89 males with NGU, including 15 patients with persistent or recurrent NGU and 1 patient with post-gonococcal urethritis, with a 100-mg twice-daily dose regimen of sitafloxacin to assess its efficacy against NGU. We examined first-void urine samples for the presence of C. trachomatis, M. genitalium, Ureaplasma parvum, and Ureaplasma urealyticum. After treatment, we evaluated 73 patients for clinical outcomes and 44 for microbiological outcomes. Symptoms were alleviated in 62 (84.9%) patients, who were judged clinically cured. Microorganisms detected before treatment were eradicated in 42 (95.5%) patients, who were judged microbiologically cured. Regarding microbiological outcomes of specific microorganisms, eradication rates of C. trachomatis (n = 33), M. genitalium (n = 11), and U. urealyticum (n = 10) were 100%, 100%, and 80.0%, respectively. In all 5 patients with M. genitalium-positive persistent or recurrent NGU who had experienced treatment failures with antibiotics, the mycoplasma was eradicated. These results suggested that the sitafloxacin regimen used, which was effective on both M. genitalium and C. trachomatis infections, could be useful as an appropriate option as first- and second-line treatment of NGU.
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Affiliation(s)
- Shin Ito
- iClinic, 7-19-26 Naga-machi, Taihaku-ku, Sendai 982-0011, Japan
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