Persistent high macrolide resistance rate and increase of macrolide-resistant ST14 strains among Mycoplasma pneumoniae in South Korea, 2019–2020

Lee, Joon Kee; Choi, Youn Young; Sohn, Young Joo; Kim, Kyung Min; Kim, Ye Kyung; Han, Mi Seon; Park, Ji Young; Cho, Eun Young; Choi, Jae Hong; Choi, Eun Hwa

doi:10.1016/j.jmii.2021.07.011

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…Thus, continuous monitoring is needed to evaluate and understand the correlations between the MR rate of clinical isolates, drug consumption, and genotype shift of circulating strains. The MR rate of the type 2 lineage remains low in Japan; however, a higher MR rate of the type 2 lineage has recently been reported in China and South Korea ( Wang et al, 2021 ; Guo et al, 2022 ; Lee et al, 2022 ; Wang et al, 2022 ). Therefore, it is particularly important to monitor the MR rate of the type 2 lineage strains in Japan.…”

Section: Discussionmentioning

confidence: 90%

“…Since the late 2010s, type 2 lineage strains have become clinically prevalent in Japan, and most of these type 2 lineage strains are MSMP. However, in China and South Korea, a gradual increase in the MR rate of the type 2 lineage has been reported in recent years ( Wang et al, 2021 ; Guo et al, 2022 ; Lee et al, 2022 ; Wang et al, 2022 ). Therefore, it is particularly important to monitor the MR rate of the type 2 lineage strains in Japan.…”

Section: Introductionmentioning

confidence: 99%

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Genotyping of Mycoplasma pneumoniae strains isolated in Japan during 2019 and 2020: spread of p1 gene type 2c and 2j variant strains

Kenri

Yamazaki²,

Ohya

et al. 2023

Front. Microbiol.

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We characterized 118 Mycoplasma pneumoniae strains isolated from three areas of Japan (Saitama, Kanagawa, and Osaka) during the period of 2019 and 2020. Genotyping of the p1 gene in these strains revealed that 29 of them were type 1 lineage (29/118, 24.6%), while 89 were type 2 lineage (89/118, 75.4%), thereby indicating that type 2 lineage was dominant in this period. The most prevalent variant of type 2 lineage was type 2c (57/89, 64%), while the second-most was type 2j, a novel variant identified in this study (30/89, 33.7%). Type 2j p1 is similar to type 2 g p1, but cannot be distinguished from reference type 2 (classical type 2) using the standard polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) with HaeIII digestion. Thus, we used MboI digestion in the PCR-RFLP analysis and re-examined the data from previous genotyping studies as well. This revealed that most strains reported as classical type 2 after 2010 in our studies were actually type 2j. The revised genotyping data showed that the type 2c and 2j strains have been spreading in recent years and were the most prevalent variants in Japan during the time-period of 2019 and 2020. We also analyzed the macrolide-resistance (MR) mutations in the 118 strains. MR mutations in the 23S rRNA gene were detected in 29 of these strains (29/118, 24.6%). The MR rate of type 1 lineage (14/29, 48.3%) was still higher than that of type 2 lineage (15/89, 16.9%); however, the MR rate of type 1 lineage was lower than that found in previous reports published in the 2010s, while that of type 2 lineage strains was slightly higher. Thus, there is a need for continuous surveillance of the p1 genotype and MR rate of M. pneumoniae clinical strains, to better understand the epidemiology and variant evolution of this pathogen, although M. pneumoniae pneumonia cases have decreased significantly since the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Genotyping of Mycoplasma pneumoniae strains isolated in Japan during 2019 and 2020: spread of p1 gene type 2c and 2j variant strains

Kenri

Yamazaki²,

Ohya

et al. 2023

Front. Microbiol.

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“…Current literature along with our study results afrms that doxycycline appears to be a proper alternative to macrolides, in combination with a β-lactam for nonsevere inpatients with CAP as supported by current (ATS/IDSA) guideline recommendations. Tese fndings would be of importance to those interested in cost diference, risk of Clostridium difcile rate, cardiovascular mortality, and the persistent increase of macrolide-resistance towards important respiratory pathogens [23,[25][26][27][28][29]. Practitioners should outweigh the risk versus beneft when choosing between these agents.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effectiveness and Outcomes of Azithromycin versus Doxycycline Containing Regimen in Inpatients with Community Acquired Pneumonia: A Retrospective Cohort Study

Babonji

Alshehri

Alturaiki

2023

Journal of Clinical Pharmacy and Therapeutics

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Background. Community acquired pneumonia (CAP) is a common serious infection that is usually treated with a macrolide with a β-lactam while doxycycline is considered an alternative due to limited evidence. Hence, we aimed to evaluate azithromycin versus doxycycline containing regimen in achieving clinical stability for inpatients with CAP. Materials and Methods. a retrospective cohort of inpatients with CAP receiving either azithromycin or doxycycline combined with a β-lactam. The primary endpoint was the percentage of patients who achieved clinical stability within 3 days, while secondary endpoints were the average days required to achieve clinical stability. Results. A total of 447 were included of which 379 received azithromycin while 68 received doxycycline containing regimen. The average age of the study population was 65.4 ± 21.1, of which 49% were females. Ceftriaxone was the most prescribed β-lactam. Majority of this cohort had a length of hospital stay of 5 days or less. Total percentage of patients who achieved clinical stability within 3 days were 257 (57.5%), of which 222 (58.6%) were in azithromycin group versus 35 (51.5%) in doxycycline containing regimen group; p = 0.275 . While the average day required to achieve clinical stability in both groups was 3.8 ± 3.2, in which 3.8 ± 3.3 in azithromycin versus 3.9 ± 2.7 in doxycycline containing regimen; (95% CI −0.98–0.68; p = 0.727 ) Conclusions. These findings support that doxycycline is comparable in efficacy to macrolides with a β-lactam for inpatients with CAP as supported by current guideline recommendations.

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“…The findings of this study may not be consistent in other strains, especially the P1 type 2 strains, because ST3 is a P1 type 1 strain. The macrolide resistance of P1 type 2 strains is relatively low compared to that of P1 type 1 strains, although resistance has increased recently in certain regions [42][43][44]. Therefore, other mechanisms of macrolide resistance, including but not limited to the R-M system, may occur in P1 type 2 strains.…”

Section: Discussionmentioning

confidence: 99%

Association of Tandem Repeat Number Variabilities in Subunit S of the Type I Restriction-Modification System with Macrolide Resistance in Mycoplasma pneumoniae

Lee

Seong

Yun

et al. 2022

JCM

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Mycoplasma pneumoniae is one of the major pathogens responsible for pneumonia in children. Modern molecular genetics has advanced both the management and the epidemiologic study of this disease. Despite these advancements, macrolide resistance remains a global threat in the management of M. pneumoniae infection, for which the genetic background remains unrevealed. In this study, the result of whole genome analysis of 20 sequence type 3 (ST3) M. pneumoniae strains were examined to investigate the gene(s) associated with macrolide resistance. Overall, genetic similarities within M. pneumoniae, and especially ST3, were very high (over 99.99 %). Macrolide resistant ST3 strains shared 20 single nucleotide polymorphisms, of which one gene (mpn085) was found to be associated with resistance. BLAST comparison of M. pneumoniae revealed regular tandem repeat number variabilities between macrolide-susceptible and resistant strains for genes coding the Type I restriction-modification (R-M) system of subunit S (HsdS). Of the ten known HsdS genes, macrolide resistance was determined by the unique tandem repeat of mpn085 and mpn285. In conclusion, the use of whole genome sequencing (WGS) to target macrolide resistance in M. pneumoniae indicates that the determinant of macrolide resistance is variabilities in the tandem repeat numbers of the type I R-M system in subunit S.

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Persistent high macrolide resistance rate and increase of macrolide-resistant ST14 strains among Mycoplasma pneumoniae in South Korea, 2019–2020

Cited by 10 publications

References 21 publications

Genotyping of Mycoplasma pneumoniae strains isolated in Japan during 2019 and 2020: spread of p1 gene type 2c and 2j variant strains

Genotyping of Mycoplasma pneumoniae strains isolated in Japan during 2019 and 2020: spread of p1 gene type 2c and 2j variant strains

Clinical Effectiveness and Outcomes of Azithromycin versus Doxycycline Containing Regimen in Inpatients with Community Acquired Pneumonia: A Retrospective Cohort Study

Association of Tandem Repeat Number Variabilities in Subunit S of the Type I Restriction-Modification System with Macrolide Resistance in Mycoplasma pneumoniae

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