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Original research
An alarming high prevalence of resistance-associated mutations to macrolides and fluoroquinolones in Mycoplasma genitalium in Belgium: results from samples collected between 2015 and 2018
  1. Irith De Baetselier1,
  2. Chris Kenyon2,
  3. Wim Vanden Berghe3,
  4. Hilde Smet1,
  5. Kristien Wouters2,
  6. Dorien Van den Bossche1,
  7. Bea Vuylsteke4,
  8. Tania Crucitti5
  1. 1Department of Clinical Sciences, STI Reference Laboratory, Institute of Tropical Medicine, Antwerpen, Belgium
  2. 2Department of Clinical Sciences, STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
  3. 3Epidemiology of Infectious Diseases, Sciensano, Brussel, Belgium
  4. 4Public Health, HIV/STI Unit, Institute of Tropical Medicine, Antwerpen, Belgium
  5. 5Centre de Pasteur de Cameroon, Antwerp, Belgium
  1. Correspondence to Dr Irith De Baetselier, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen 2000, Belgium; idebaetselier{at}


Objectives The number of reported cases of multiresistant Mycoplasma genitalium (MG) is increasing globally. The aim of this study was to estimate the prevalence of macrolide and possible fluoroquinolone resistance-associated mutations (RAMs) of MG in Belgium.

Methods The study was performed retrospectively on two sets of MG-positive samples collected in Belgium between 2015 and 2018. The first set of samples originated from routine surveillance activities and the second set came from a cohort of men who have sex with men (MSM) using pre-exposure prophylaxis to prevent HIV transmission. Detection of RAMs to macrolides and fluoroquinolones was performed on all samples using DNA sequencing of the 23S ribosomal RNA gene, the gyrA gene and the parC gene.

Results Seventy-one per cent of the MG samples contained a mutation conferring resistance to macrolides or fluoroquinolones (ParC position 83/87). RAMs were more frequently found among men compared with women for fluoroquinolones (23.9% vs 9.1%) and macrolides (78.4% vs 27.3%). Almost 90% of the MG infections among MSM possessed a RAM to macrolides (88.4%). In addition, 18.0% of the samples harboured both macrolides and fluoroquinolone RAMs; 3.0% in women and 24.2% in MSM. Being MSM was associated with macrolide RAMs (OR 15.3), fluoroquinolone RAMs (OR 3.8) and having a possible multiresistant MG infection (OR 7.2).

Conclusion The study shows an alarmingly high prevalence of MG with RAMs to macrolides and fluoroquinolones in Belgium. These results highlight the need to improve antimicrobial stewardship in Belgium in order to avoid the emergence of untreatable MG.

  • Mycoplasma genitalium
  • antimicrobial resistance
  • Belgium
  • fluoroquinolones
  • macrolides

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  • Handling editor Federico Garcia

  • BV and TC contributed equally.

  • Contributors IDB wrote the initial draft with BV, TC and CK. IDB analysed the results. HS performed the experimental work. All authors reviewed and commented on the manuscript.

  • Funding Additional funding was received by Sciensano to perform the detection of resistance-associated mutations for macrolides and fluoroquinolones.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Be-PrEP-ared study was approved by the Ethics Committee of the University of Antwerp and the Institutional Review Board of the ITM. All individuals provided informed consent. Supplementary ethics approval was obtained for the detection of RAMs in MG-positive samples for both the Be-PrEP-ared study (988/15 and 15/25/255) and the surveillance samples (1374/20).

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

  • Data availability statement Data are available on reasonable request. The data supporting the findings of this publication are retained at the Institute of Tropical Medicine (ITM), Antwerp and will not be made openly accessible due to ethical and privacy concerns. According to the ITM research data sharing policy, only fully anonymised data can be shared publicly. The surveillance data are de-identified (using a unique patient code) but not fully anonymised and it is not possible to fully anonymise them due to the longitudinal nature of the data. Data can however be made available after approval of a motivated and written request to the ITM at The ITM data access committee will verify if the dataset is suitable for obtaining the study objective and will assure that confidentiality and ethical requirements are in place.

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