Resistance of Mycoplasma pneumoniae to erythromycin and other antibiotics

Niitu, Y; Hasegawa, Shota; Suetake, Takaki; Kubota, Hidekazu; Komatsu, Shigeo; Horikawa, Masahiro

doi:10.1016/s0022-3476(70)80485-1

Cited by 71 publications

(42 citation statements)

References 11 publications

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“…Concerning erythromycin susceptibility, two macrolide-resistant clinical isolates were identified. Except in Japan where macrolide-resistant M. pneumoniae isolates were first found in 1968 (14) and have been spreading since 2000 (12,13), very few strains resistant to erythromycin were reported in the literature elsewhere in the world. Three erythromycin-resistant clinical isolates were reported in Israel during the 1980s (18), and two resistant isolates from the United States and Finland were collected between 1995 and 1999 (4).…”

Section: Discussionmentioning

confidence: 99%

First Report of Macrolide-Resistant Strains and Description of a Novel Nucleotide Sequence Variation in the P1 Adhesin Gene in Mycoplasma pneumoniae Clinical Strains Isolated in France over 12 Years

Pereyre¹,

Charron

Renaudin

et al. 2007

J Clin Microbiol

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Mycoplasma pneumoniae isolates are divided in two types based on the sequence variations in the P1 adhesin gene. The type of P1 adhesin gene of 155 clinical isolates of M. pneumoniae collected in France between 1994 and 2006 was determined by a PCR-restriction fragment length polymorphism method. Until 1995, all strains belonged to type 1. In 1996 and 1997, type 1 was still predominant, but type 2 increased. Finally, since 1998, both types were present in about the same proportion. In our study, a novel sequence of the P1 adhesin gene was described in one strain. This strain could not be classified into type 1 or 2 because of variability in both P1 gene repeat elements, RepMP4 and RepMP2/3. This new sequence was certainly issued from recombination with repetitive sequences localized outside of the P1 gene in the M. pneumoniae chromosome. Moreover, MICs of erythromycin, tetracycline, and ciprofloxacin were determined for the 155 isolates. All isolates remained susceptible to tetracycline and ciprofloxacin, but two macrolide-resistant strains, isolated from two children in 1999, were identified. They harbored an A-to-G substitution at position 2058 or 2059 (Escherichia coli numbering) in domain V of 23S rRNA, associated with resistance to macrolides, lincosamides, and ketolides. To our knowledge, this is the first description of macrolide-resistant isolates of M. pneumoniae in France, but at this time, there is no sign of recent diffusion of resistant strains.Mycoplasma pneumoniae is a common pathogen responsible for community-acquired respiratory tract infections, particularly in school-aged children and young adults. Epidemics occur periodically at 4-to 7-year intervals (22). The 170-kDa P1 protein is a major adhesin protein that induces a strong immunological response (1,10,22). Only one copy of a functional full-length P1 gene is present in the M. pneumoniae genome (9). This gene is composed by two repetitive regions, RepMP4 located at the 5Ј end of the coding region and RepMP2/3 located at the 3Ј end of the coding region (16). Eight to 10 closely related but not identical copies of both repetitive regions are dispersed through the fully sequenced genome of the M. pneumoniae M129 strain (16). Based on the sequence of the P1 gene, two types, 1 and 2, have been reported (3,20). M. pneumoniae M129 is a type 1 prototype, while M. pneumoniae FH, Mac, and 1842 strains belong to type 2. Moreover, one type 1 variant and two type 2 variants that showed sequence variations in the RepMP2/3 but not the RepMP4 element of the P1 gene have been described (6,8,11).Previous studies found that one or the other of the two types tended to predominate among clinical isolates in specific geographical regions and that the predominant type changed over time (3,7,17,20). These changes in the P1 adhesin type may play a role in the development of outbreaks. In France, the 1987 and 1992 epidemics were due to strains belonging to type 2 and 1, respectively (3).Macrolides are the drug of choice for the treatment of M. pneumoniae infections...

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Section: Discussionmentioning

confidence: 99%

First Report of Macrolide-Resistant Strains and Description of a Novel Nucleotide Sequence Variation in the P1 Adhesin Gene in Mycoplasma pneumoniae Clinical Strains Isolated in France over 12 Years

Pereyre¹,

Charron

Renaudin

et al. 2007

J Clin Microbiol

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“…There are few reports on the isolation of MR M. pneumoniae from clinical specimens, and most of the isolates were obtained following ERY treatment (13,19). In our survey, MR M. pneumoniae was not found in any of 296 clinical isolates or 12 M. pneumoniae PCR-positive specimens collected between 1983 and 1999, but it has been found in 15% to 20% of clinical isolates or PCR-positive specimens since 2000.…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of Macrolide-Resistant Mycoplasma pneumoniae

Suzuki

Yamazaki

Narita³

et al. 2006

Antimicrob Agents Chemother

158

119

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Macrolide-resistant Mycoplasma pneumoniae (MR M. pneumoniae) has been isolated from clinical specimens in Japan since 2000. A comparative study was carried out to determine whether or not macrolides are effective in treating patients infected with MR M. pneumoniae. The clinical courses of 11 patients with MR M. pneumoniae infection (MR patients) treated with macrolides were compared with those of 26 patients with macrolide-susceptible M. pneumoniae infection (MS patients). The total febrile days and the number of febrile days during macrolide administration were longer in the MR patients than in the MS patients (median of 8 days versus median of 5 days [P ‫؍‬ 0.019] and 3 days versus 1 day [P ‫؍‬ 0.002], respectively). In addition, the MR patients were more likely than the MS patients to have had a change of the initially prescribed macrolide to another antimicrobial agent (63.6% versus 3.8%; odds ratio, 43.8; P < 0.001), which might reflect the pediatrician's judgment that the initially prescribed macrolide was not sufficiently effective in these patients. Despite the fact that the febrile period was prolonged in MR patients given macrolides, the fever resolved even when the initial prescription was not changed. These results show that macrolides are certainly less effective in MR patients.Mycoplasma pneumoniae is a common pathogen causing community-acquired respiratory tract infection mainly in children and young adults. Macrolides are generally considered to be the first-choice agents for treatment of M. pneumoniae infection. Although tetracyclines and fluoroquinolones are effective against M. pneumoniae, these agents are not recommended for children because of their toxicity. Tetracyclines can cause depression of bone growth, permanent gray-brown discoloration of the teeth, and enamel hypoplasia when given during tooth development. Although the clinical importance of fluoroquinolones has not been demonstrated, they produce cartilage erosion in young animals. Thus, these agents should be given only when there is no alternative (15).As reported by Lucier et al. (9) and Okazaki et al. (14), an A-to-G transition or A-to-C transversion at position 2063 or 2064 of domain V of the M. pneumoniae 23S rRNA gene results in resistance to macrolide antibiotics. We have previously reported the isolation of macrolide-resistant (MR) M. pneumoniae from ca. 20% of clinical specimens collected from pediatric patients in Japan (11). Most of those isolates were highly resistant to 14-membered ring macrolides (MIC, Ͼ256 g/ml) and moderately resistant to 15-and 16-membered ring macrolides.Even in the cases of patients infected with MR M. pneumoniae, some pediatricians had the impression that there was a good response to macrolide therapy (11). There is a similar debate about the management of infection due to pneumococci. As noted in The Infectious Diseases Society of America (IDSA) guidelines for community-acquired pneumonia management (10), despite the increase of resistant isolates, a corresponding increase has not been seen in...

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“…However, organisms from acute M. pneumoniae infections are seldom sought by culture, they are almost never tested for in vitro susceptibilities for clinical purposes, and most in vitro studies reported to date tested relatively small numbers of clinical isolates from limited geographic areas. Organisms can be shed in respiratory secretions for long periods after acute infection, and high-level-macrolide-resistant strains have been isolated following erythromycin treatment, but resistance did not appear to affect clinical outcome (310,394). Macrolide-resistant M. pneumoniae mutants can easily be selected in vitro (311,393,394); such mutants typically exhibit the macrolide-lincosamide-streptogramin Btype resistance, rendering lincosamides and streptogramin B inactive in addition to the macrolides.…”

Section: Antimicrobial Susceptibility Profilesmentioning

confidence: 99%

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

2004

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Mycoplasma pneumoniae is a unique bacterium that does not always receive the attention it merits considering the number of illnesses it causes and the degree of morbidity associated with it in both children and adults. Serious infections requiring hospitalization, while rare, occur in both adults and children and may involve multiple organ systems. The severity of disease appears to be related to the degree to which the host immune response reacts to the infection. Extrapulmonary complications involving all of the major organ systems can occur in association with M. pneumoniae infection as a result of direct invasion and/or autoimmune response. The extrapulmonary manifestations are sometimes of greater severity and clinical importance than the primary respiratory infection. Evidence for this organism's contributory role in chronic lung conditions such as asthma is accumulating. Effective management of M. pneumoniae infections can usually be achieved with macrolides, tetracyclines, or fluoroquinolones. As more is learned about the pathogenesis and immune response elicited by M. pneumoniae, improvement in methods for diagnosis and prevention of disease due to this organism may occur

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Resistance of Mycoplasma pneumoniae to erythromycin and other antibiotics

Cited by 71 publications

References 11 publications

First Report of Macrolide-Resistant Strains and Description of a Novel Nucleotide Sequence Variation in the P1 Adhesin Gene in Mycoplasma pneumoniae Clinical Strains Isolated in France over 12 Years

First Report of Macrolide-Resistant Strains and Description of a Novel Nucleotide Sequence Variation in the P1 Adhesin Gene in Mycoplasma pneumoniae Clinical Strains Isolated in France over 12 Years

Clinical Evaluation of Macrolide-Resistant Mycoplasma pneumoniae

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

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