Estimation of antimicrobial resistance of Mycoplasma genitalium, Belgium, 2022

Abstract

Background Antimicrobial resistance (AMR) of Mycoplasma genitalium (MG) is a growing concern worldwide and surveillance is needed. In Belgium, samples are sent to the National Reference Centre of Sexually Transmitted Infections (NRC-STI) on a voluntary basis and representative or robust national AMR data are lacking. Aim We aimed to estimate the occurrence of resistant MG in Belgium. Methods Between July and November 2022, frozen remnants of MG-positive samples from 21 Belgian laboratories were analysed at the NRC-STI. Macrolide and fluoroquinolone resistance-associated mutations (RAMs) were assessed using Sanger sequencing of the 23SrRNA and parC gene. Differences in resistance patterns were correlated with surveillance methodology, socio-demographic and behavioural variables via Fisher’s exact test and logistic regression analysis. Results Of the 244 MG-positive samples received, 232 could be sequenced for macrolide and fluoroquinolone RAMs. Over half of the sequenced samples (55.2%) were resistant to macrolides. All sequenced samples from men who have sex with men (MSM) (24/24) were macrolide-resistant. Fluoroquinolone RAMs were found in 25.9% of the samples and occurrence did not differ between socio-demographic and sexual behaviour characteristics. Conclusion Although limited in sample size, our data suggest no additional benefit of testing MG retrieved from MSM for macrolide resistance in Belgium, when making treatment decisions. The lower occurrence of macrolide resistance in other population groups, combined with emergence of fluoroquinolone RAMs support macrolide-resistance testing in these groups. Continued surveillance of resistance in MG in different population groups will be crucial to confirm our findings and to guide national testing and treatment strategies.

Detection of Macrolide and/or Fluoroquinolone Resistance Genes in Mycoplasma genitalium Strains Isolated from Men in the Northwest Region of Croatia in 2018–2023

“…Moreover, in a recent study conducted in Belgium, De Baetselier et al [16] reported a significant prevalence of macrolide-resistant M. genitalium across various populations in Belgium. Specifically, among men, 72.4% of the samples analysed in the study exhibited genotypic resistance to macrolides [16].…”

“…Moreover, in a recent study conducted in Belgium, De Baetselier et al [16] reported a significant prevalence of macrolide-resistant M. genitalium across various populations in Belgium. Specifically, among men, 72.4% of the samples analysed in the study exhibited genotypic resistance to macrolides [16]. Despite the study's limited sample size, all specimens obtained from MSM displayed mutations associated with macrolide resistance, likely attributed to the use of macrolides in treating other STIs or unrelated infections [17].…”

“…These treatment protocols, typically involving a single dose of 1 g azithromycin, are suboptimal for M. genitalium and may contribute to the development of antimicrobial resistance and the persistence of macrolide-resistant strains [1]. Consequently, in 2022, many countries-including Belgium-adjusted their STI treatment guidelines to minimize the use of azithromycin and thereby mitigate the emergence of azithromycin-resistant M. genitalium strains, as well as other STI pathogens [16]. A similar strategic approach may be warranted in Croatia to address the escalating concern of antimicrobial resistance in M. genitalium and other STIs.…”