Background Treatment for Mycoplasma genitalium is becoming increasingly complicated by antimicrobial resistance. We summarised published global data on the prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium and examined trends over time.
Methods We searched PubMed, EMBASE and Medline until December 31, 2017. We included studies that reported the percentage of key mutations associated with macrolide resistance (23S rRNA gene: A2071C/G/T; A2072C/G/T) and/or fluoroquinolone failure (parC gene: S83R/I; D87N/Y) among M. genitalium positive specimens. Data were extracted by geographic region, collection year, sex, and risk group (men who have sex with men [MSM] or heterosexual). Summary estimates (95% confidence intervals [CI]) were calculated using random-effects meta-analyses. Subgroup and meta-regression analyses were conducted to assess heterogeneity.
Results 47 studies met the inclusion criteria reporting resistance-associated mutations for macrolides (n=45) and fluoroquinolones (n=18). Global prevalence of macrolide resistance mutations increased from 4.9% [95% CI 0.0–15.7%] before 2009, to 46.3% [30.7–62.2%] in 2016–17 (p-trend=0.001). This increase was greatest in the Western Pacific region (Australia in particular) where prevalence increased from 12.6% [2.6–26.9%] to 69.2% [60.7–77.1%] (p-trend<0.001). Prevalence of macrolide resistance-associated mutations was also higher among MSM (72.3% [58.6–84.5%]) than heterosexual men (37.3% [25.8–49.6%]) (p<0.001). Global prevalence of fluoroquinolone resistance mutations was 6.3% [4.2–8.9%] with no changes over time or by risk group, but regional variations were present with highest prevalence in the Western Pacific region (14.9% [9.7–20.9%]) and North America (11.2% [2.9–23.3%]), and lowest in Europe (2.8% [1.7–4.1%]). Dual class resistance mutation prevalence was 2.5% [1.1–4.2%] with no change over time or by risk group. Regional variations were similar to those for fluoroquinolone resistance mutations.
Conclusion Resistance to recommended first and second line treatments for M. genitalium is a growing public health problem. Global surveillance and antimicrobial resistance-guided therapies are needed to inform more effective regional strategies for the control and treatment of M. genitalium.
Disclosure No significant relationships.
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