Prevalence of macrolide and fluoroquinolone resistance-associated mutations in Mycoplasma genitalium in metropolitan and overseas France

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.

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

“…Conversely, fluoroquinolone resistance rates ranged from 17.1% to 19.8% in the same geographic region, with no statistically significant differences observed between men and women. Intriguingly, the prevalence of dual resistance-associated mutations was found to be significantly higher among men compared to women during the years 2018 and 2019 [15]. Although this study did not include female patients, the rates in men were comparable to our results, emphasizing the importance of vigilance in monitoring antimicrobial resistance trends and implementing targeted interventions.…”

“…A recent multicentre cross-sectional study conducted to assess the prevalence of mutations associated with macrolide and fluoroquinolone resistance in M. genitaliumpositive patients in France, spanning the years 2018 to 2020, revealed notable disparities in prevalence rates between male and female individuals [15]. More specifically, across metropolitan France, there was a considerable difference in macrolide resistance prevalence, ranging from 52.4% to 60.2% among men compared to 15.9% to 22.2% among women.…”

Testing for Mycoplasma genitalium in Women With Vaginal Symptoms Should Not Be Performed Routinely

“…10,[20][21][22][23][24] Moxifloxacin efficacy may also be diminishing, as fluoroquinolone resistance has been reported. [25][26][27] Treatment comes with concerns for drug interactions and toxicities (e.g., QT interval prolongation, arthropathy). Doxycycline and moxifloxacin are not recommended for use in pregnancy because of infant tooth discoloration and birth defects in animal studies, respectively.…”

“…Cephalosporins are not active against Mycoplasmas , 18 the efficacy of doxycycline alone is approximately 30%, 19 and rates of resistance to azithromycin range from 40% to 90% 10,20–24 . Moxifloxacin efficacy may also be diminishing, as fluoroquinolone resistance has been reported 25–27 . Treatment comes with concerns for drug interactions and toxicities (e.g., QT interval prolongation, arthropathy).…”

Estimation of antimicrobial resistance of Mycoplasma genitalium, Belgium, 2022

“…Other countries, such as France and the United Kingdom (UK) have performed additional surveys to estimate antimicrobial resistance (AMR) of MG in samples from sexual health clinics or laboratories during a 1-3-month period [11][12][13]. These kinds of surveys may provide a more comprehensive picture of MG AMR.…”