An alarming high prevalence of resistance-associated mutations to macrolides and fluoroquinolones inMycoplasma genitaliumin Belgium: results from samples collected between 2015 and 2018

Abstract

ObjectivesThe number of reported cases of multiresistant Mycoplasma genitalium (MG) is increasing globally. The aim of this study was to estimate the prevalence of macrolide and possible fluoroquinolone resistance-associated mutations (RAMs) of MG in Belgium.MethodsThe study was performed retrospectively on two sets of MG-positive samples collected in Belgium between 2015 and 2018. The first set of samples originated from routine surveillance activities and the second set came from a cohort of men who have sex with men (MSM) using pre-exposure prophylaxis to prevent HIV transmission. Detection of RAMs to macrolides and fluoroquinolones was performed on all samples using DNA sequencing of the 23S ribosomal RNA gene, the gyrA gene and the parC gene.ResultsSeventy-one per cent of the MG samples contained a mutation conferring resistance to macrolides or fluoroquinolones (ParC position 83/87). RAMs were more frequently found among men compared with women for fluoroquinolones (23.9% vs 9.1%) and macrolides (78.4% vs 27.3%). Almost 90% of the MG infections among MSM possessed a RAM to macrolides (88.4%). In addition, 18.0% of the samples harboured both macrolides and fluoroquinolone RAMs; 3.0% in women and 24.2% in MSM. Being MSM was associated with macrolide RAMs (OR 15.3), fluoroquinolone RAMs (OR 3.8) and having a possible multiresistant MG infection (OR 7.2).ConclusionThe study shows an alarmingly high prevalence of MG with RAMs to macrolides and fluoroquinolones in Belgium. These results highlight the need to improve antimicrobial stewardship in Belgium in order to avoid the emergence of untreatable MG.

Prevalence of Mycoplasma genitalium fluoroquinolone-resistance markers, and dual-class-resistance markers, in asymptomatic men who have sex with men

“…Limited data are available on the trends and factors associated with fluoroquinolone-resistant M. genitalium in MSM [18, 31], particularly asymptomatic MSM. This study analyses clinical samples obtained from the MnM study of M.…”

“…MSM are a population who already experience high levels of macrolide-resistant M. genitalium, and any increase in fluoroquinolone resistance may result in dual-class-resistance strains, for which very limited treatment options are available [30]. Limited data are available on the trends and factors associated with fluoroquinolone-resistant M. genitalium in MSM [18,31], particularly asymptomatic MSM. This study analyses clinical samples obtained from the MnM study of M. genitalium in asymptomatic MSM [7], and aims to (i) determine the levels of fluoroquinolone and dual-class resistance in the cohort, (ii) explore any clinical and behavioural factor associations with fluoroquinolone resistance in M. genitalium, and (iii) determine the distribution of antibiotic resistance among M. genitalium mgpB sequence types (STs).…”

Is There a Resistance Threshold for Macrolide Consumption? Positive Evidence from an Ecological Analysis of Resistance Data from Streptococcus pneumoniae, Treponema pallidum, and Mycoplasma genitalium

“…11 More recent studies have found a much higher prevalence of macrolide resistance in both countries (74% and 58%, respectively). 37,38 These limitations mean that the results should be viewed with caution and require further validation. The way that travel can disseminate AMR may also mean that for certain bacterial species, a threshold may only be effective if globally applied.…”

Resistance-guided treatment of Mycoplasma genitalium infection at a UK sexual health centre

“…2 Treatment is challenging due to a narrow repertoire of susceptible antimicrobials and a rise of macrolide resistance (MR). Multiple studies [3][4][5] demonstrate a high prevalence of macrolide resistance-mediating mutations (MRMMs) in the 23S rRNA gene across clinical samples. Macrolide resistance in the United Kingdom is high, estimated at 41%, 6 but there is a wide range globally.…”