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Original Article
Detection of markers predictive of macrolide and fluoroquinolone resistance in Mycoplasma genitalium from patients attending sexual health services in England
  1. Rachel Pitt1,2,
  2. Helen Fifer1,2,
  3. Neil Woodford2,
  4. Sarah Alexander1
  1. 1 Sexually Transmitted Bacteria Reference Unit, National Infection Service, Public Health England, London, UK
  2. 2 Antimicrobial Resistance and Healthcare Acquired Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, UK
  1. Correspondence to Rachel Pitt, Antimicrobial Resistance in Sexually Transmitted Infections (AMRSTI), Antimicrobial Resistance and Healthcare Acquired Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, Colindale, London NW9 5EQ, UK; Rachel.Pitt{at}phe.gov.uk

Abstract

Objectives Resistance to both macrolides and fluoroquinolones has been reported in Mycoplasma genitalium; however, due to limited diagnostics, studies are often small and confined to specific geographical areas. This study sought to determine the rate of predicted resistance in M. genitalium-positive specimens referred for diagnostic testing.

Methods Seventy-four M. genitalium-positive specimens, referred to the national reference laboratory (2010-2013) from 19 centres across England, were blinded and anonymised. Specimens were examined for markers predictive of resistance to macrolides and fluoroquinolones using PCR followed by sequence analysis of 23S rRNA gene, or gyrA and parC, respectively.

Results 23S rRNA gene PCR sequencing revealed that 82.4% (61/74) of specimens harboured a single nucleotide polymorphism (SNP) associated with macrolide resistance. Differences were observed between the rates of predicted macrolide resistance in male (95.1% (58/61)) and female (23.1% (3/13)) patients (P = <0.001). By contrast, all specimens for which sequencing data were available (73/74) yielded wild-type gyrA sequences; and 58/61 (95.1%) had wild-type parC genes. Three specimens (3/61 4.9%) had SNPs in the parC gene associated with fluoroquinolone treatment failure, and all three also had predicted resistance to macrolides.

Conclusions Eighty-two per cent and 4.9% of M. genitalium specimens had SNPs associated with macrolide and fluoroquinolone resistance, respectively. Due to lack of widespread availability of testing for M. genitalium in the UK, this study sample was likely to be sourced from patients who may have already failed first-line macrolide therapy. Nevertheless, this study highlights the need for both greater access to M. genitalium diagnostics and genetic antimicrobial resistance testing.

  • m genitalium
  • antibiotic resistance
  • treatment

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Footnotes

  • Handling editor Jackie A Cassell

  • Contributors RP carried out all the laboratory work and prepared the first draft of the manuscript for this study. SA supervised this work and contributed to the manuscript. HF and NW contributed to the manuscript and the analysis of results.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Since the laboratory work described in this report was completed, AMRHAI has received funding from SpeeDx for a kit evaluation. HF has participated in the Consensus Steering Group for Mycoplasma genitalium diagnosis in the UK, arranged and funded by Hologic.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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