Article Text

Download PDFPDF
Short report
Detection of markers predictive of macrolide and fluoroquinolone resistance in Mycoplasma genitalium from patients attending sexual health services
  1. Michaela Joanne Day1,
  2. Michelle Jayne Cole1,
  3. Helen Fifer2,
  4. Neil Woodford1,
  5. Rachel Pitt1
  1. 1Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), National Infection Service, Public Health England, London, UK
  2. 2Blood Safety, Hepatitis, Sexually-Transmitted Infections and HIV Division, National Infection Service, Public Health England, London, UK
  1. Correspondence to Dr Michaela Joanne Day, Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), National Infection Service, Public Health England National Infection Service, London NW9 5EQ, UK; michaela.day{at}phe.gov.uk

Abstract

Objectives This study sought to provide data on the prevalence of macrolide (23S rRNA) and fluoroquinolone (parC) resistance-associated mutations seen in Mycoplasma genitalium-positive specimens received in the UK national reference laboratory.

Methods In total, 2580 clinical specimens from patients with suspected or confirmed M. genitalium infection were received at the national reference laboratory between September 2017 and November 2018. M. genitalium-positive clinical specimens were identified using a reverse transcription-PCR targeting two M. genitalium genes: MgPa and gap. Resistance-associated single nucleotide poylmorphisms were sought in all positive specimens by sequence analysis of the 23S rRNA and parC genes.

Results Eighteen per cent (458 of 2580) of clinical specimens were positive for M. genitalium and 389 had sequence data for both macrolide and fluoroquinolone resistance markers. Of these, 71% (275 of 389) had macrolide resistance-associated mutations, 8% (31 of 389) had fluoroquinolone resistance-associated mutations (S83I/R and D87Y/N) and 7% (26 of 389) had mutations associated with resistance to both antimicrobials. Only 28% (108 of 389) had no mutations associated with resistance to either class of antibiotic. Five specimens had mutations of unknown clinical significance in the parC gene (eg, G81C and S83N).

Conclusions Mutations associated with resistance to macrolides were very frequent. By contrast, susceptibility to the second-line treatment, moxifloxacin (a fluoroquinolone), was estimated at 92% based on the absence of resistance-associated mutations. The few specimens with mutations of unknown clinical significance in the parC gene were excluded from the analysis and so the actual level of fluoroquinolone susceptibility may be slightly lower than that reported here. Surveillance of antimicrobial resistance in M. genitalium is imperative for this to remain a treatable infection.

  • drug resistance
  • bacterial
  • mycoplasma genitalium
  • azithromycin

Statistics from Altmetric.com

Footnotes

  • Handling editor Sevgi O Aral

  • Contributors MJD prepared the first draft of the manuscript. RP, MJC, HF and NW contributed to the analysis of results and subsequent drafts of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.