An alarming high prevalence of resistance associated mutations to macrolides and fluoroquinolones in Mycoplasma genitalium in Belgium: Results from samples collected between 2015-2018

Abstract

Objectives: The number of reported cases of multi-resistant Mycoplasma genitalium (Mg) is increasing globally. The aim of this study was to estimate the prevalence of macrolide and possible fluoroquinolone resistance associated mutations (RAMs) of Mg in Belgium. Methods: The study was performed retrospectively on two sets of Mg positive samples collected in Belgium between 2015-2018. The first set of samples originated from routine surveillance activities and the second set came from a cohort of men who have sex with men (MSM) using pre-exposure prophylaxis to prevent HIV transmission. Detection of RAMs to macrolides and fluoroquinolones was performed on all samples using DNA sequencing of the 23S ribosomal RNA gene, the gyrA gene and the parC gene. Results: Seventy-six percent 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 to women for fluoroquinolones (28.7% vs 9.1%) and macrolides (82.9% vs 27.3%). More than 90% of the Mg infections among MSM possessed a RAM to macrolides (90.7%). In addition, 23.4% of the samples harboured both macrolides and fluoroquinolone RAMs; 3.0% in women and 30.7% in MSM. Being MSM was associated with macrolide RAMs (Odds ratio: 15.1), fluoroquinolone RAMs (Odds ratio: 3.4) and having a possible multi-resistant Mg infection (Odds ratio: 8.2). Conclusion: The study shows an alarmingly high prevalence of Mg with RAMs to macrolides and fluoroquinolones in Belgium. These results highlight the need to improve antimicrobial stewardship in Belgium in order to avoid the emergence of untreatable Mg.

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

“…Another study from Belgium (from 2015 to 2018) examined levels of fluoroquinolone-resistance-associated mutations, but participants were not stratified by symptom status and either sex or sexual behaviour [31]. Both the levels of clinically relevant parC SNPs and dual-class resistance in asymptomatic male and female patients was 21.5 % [31].…”

“…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).…”

Impact of changing reimbursement criteria on the use of fluoroquinolones in Belgium

“…7 Resistance to fluoroquinolones in the Belgian community has been reported for several pathogens such as Streptococcus pyogenes, Helicobacter pylori, Mycoplasma genitalium and Escherichia coli . 8–12 Although the fluoroquinolone use expressed in DID decreased from 2.77 in 2012 to 2.17 in 2017, this number still remains too high in comparison to fluoroquinolone use in Europe with an average of 1.47 DID calculated from 27 countries in 2017. 13…”

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

“…The resistance prevalence estimates from both countries were derived from relatively old studies used in the systematic review (9). More recent studies have found a much higher prevalence of macrolide resistance in both countries (74% and 58%, respectively) (35, 36). These limitations mean that the results should be viewed with caution and require further validation.…”