Pedro Kourí Tropical Medicine Institute, La Habana, Cuba.
Faculty of Biology, University of Havana, La Habana, Cuba.
BMC Infect Dis. 2018 Nov 29;18(1):601. doi: 10.1186/s12879-018-3523-9.
The increasing prevalence of macrolide resistant Mycoplasma genitalium is a major concern worldwide. In Cuba, several cases of clinical treatment failure with 1 g single dose and extended azithromycin regimen have been detected and the aim of the present investigation was to retrospectively determine the prevalence of macrolide-resistance mediating mutations (MRMM) in M. genitalium-positive samples conserved at the Cuban National Reference Laboratory of Mycoplasma Research between 2009 and 2016.
A total of 280 positive DNA extracts were analysed by a 5' nuclease assay for detection of M. genitalium MRMM. Ten urogenital specimens from patients with azithromycin treatment failure and MRMM were inoculated in Vero cell to obtain the isolates for subsequent determination of antimicrobial susceptibility.
The overall prevalence of MRMM was 32%. No MRMM was detected in samples collected between 2009 and 2013 but since 2014 a dramatic increase to 90% (95% CI, 76-96%) in 2016 was seen. Three new M. genitalium isolates were isolated in Vero cell cultures and confirmed phenotypic resistance to macrolides in a cell-culture assisted susceptibility test. Preliminary observations suggest that combination therapy with levofloxacin and doxycycline may represent an affordable option for treatment of macrolide resistant M. genitalium infections.
This investigation showed the rapid emergence and high prevalence of MRMM in M. genitalium-infected patients in Cuba and confirmed the phenotypic resistance in isolates carrying MRMM. We suggest that Cuban guidelines for sexually transmitted infections are modified to include testing for M. genitalium and detection of MRMM in patients with failure of syndromic treatment, to ensure that in these cases, the treatment will be guided by etiologic diagnosis.
越来越多的肺炎支原体对大环内酯类药物耐药是全世界关注的主要问题。在古巴，已经发现了几例临床治疗失败的病例，这些病例使用了 1 克单剂量和延长阿奇霉素方案治疗，本研究的目的是回顾性确定 2009 年至 2016 年古巴国家支原体研究参考实验室保存的 M. 生殖器阳性样本中存在的大环内酯类耐药中介突变 (MRMM)的流行率。
使用 5'核酸酶检测法对 280 份阳性 DNA 提取物进行分析，以检测 M. 生殖器 MRMM。从阿奇霉素治疗失败且具有 MRMM 的患者的 10 份泌尿生殖道标本中接种 Vero 细胞以获得分离株，随后确定抗菌药物敏感性。
MRMM 的总体流行率为 32%。在 2009 年至 2013 年期间采集的样本中未检测到 MRMM，但自 2014 年以来，2016 年急剧增加到 90%（95%CI，76-96%）。在 Vero 细胞培养物中分离出 3 株新的 M. 生殖器分离株，并在细胞培养辅助药敏试验中证实对大环内酯类药物具有表型耐药性。初步观察表明，左氧氟沙星和多西环素联合治疗可能是治疗肺炎支原体感染的一种经济实惠的选择。
本研究表明，在古巴，感染 M. 生殖器的患者中，MRMM 迅速出现且流行率较高，并证实了携带 MRMM 的分离株具有表型耐药性。我们建议修改古巴性传播感染指南，包括对综合征治疗失败的患者进行 M. 生殖器检测和检测 MRMM，以确保在这些情况下，治疗将根据病因诊断进行指导。
