Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran.
J Antimicrob Chemother. 2021 Mar 12;76(4):865-875. doi: 10.1093/jac/dkaa538.
Resistance to tetracyclines, the first-line treatment for urogenital infections caused by Mycoplasma hominis and Ureaplasma species, is increasing worldwide. The aim of the present study was to determine the global status of resistance to this class of antibiotics.
Electronic databases were searched using keywords including 'Mycoplasma', 'Mycoplasma hominis', 'M. hominis', 'Ureaplasma', 'Ureaplasma urealyticum', 'Ureaplasma parvum', 'U. urealyticum', 'U. parvum', 'Ureaplasma species', 'resistance', 'antibiotic resistance', 'antibiotic susceptibility', 'antimicrobial resistance', 'antimicrobial susceptibility', 'tetracycline', 'doxycycline' and 'minocycline'. Finally, after some exclusions, 37 studies from different countries were included in the study and meta-analysis was performed on the data collected.
The midrange resistance rates for M. hominis and U. urealyticum/parvum to tetracycline, doxycycline and minocycline were 50.0%, 9.0% and 16.7% and 43.3%, 28.6% and 9.0%, respectively. A high level of heterogeneity was observed in all studies (I2 > 50%, P value < 0.05), except those representing doxycycline resistance in M. hominis isolates (I2 = 39.1%, P = 0.02). No evidence of publication bias was observed in the studies and neither Egger's test nor Begg's test showed significant publication bias.
The results of the present study show that the overall resistance to tetracyclines is relatively high and prevalent among M. hominis and Ureaplasma species throughout the world. This highlights the importance of and necessity for regional and local antibiotic susceptibility testing before treatment choice as well as development of newer generations of tetracyclines to prevent antibiotic misuse, emergence and spread of resistant strains and, finally, the failure of treatment.
对抗生素四环素的耐药性正在全球范围内增加，四环素是治疗由人型支原体和脲原体引起的泌尿生殖系统感染的一线药物。本研究旨在确定该类抗生素耐药性的全球现状。
使用包括“支原体”、“人型支原体”、“M. hominis”、“脲原体”、“解脲脲原体”、“脲原体亚种”、“U. urealyticum”、“U. parvum”、“Ureaplasma 种属”、“耐药性”、“抗生素耐药性”、“抗生素敏感性”、“抗微生物耐药性”、“抗微生物敏感性”、“四环素”、“多西环素”和“米诺环素”等关键词，在电子数据库中进行检索。最终，经过一些排除，有 37 项来自不同国家的研究被纳入研究并进行了数据收集的荟萃分析。
人型支原体和解脲脲原体/脲原体亚种对四环素、多西环素和米诺环素的中程耐药率分别为 50.0%、9.0%和 16.7%和 43.3%、28.6%和 9.0%。除了代表人型支原体分离株对多西环素的耐药性的研究（I2=39.1%，P 值=0.02）之外，所有研究均观察到高度异质性（I2>50%，P 值<0.05）。研究中未观察到发表偏倚，Egger 检验和 Begg 检验均未显示出显著的发表偏倚。
本研究结果表明，人型支原体和脲原体种属对抗生素四环素的总体耐药率相对较高，且在全球范围内普遍存在。这突出表明，在选择治疗方案之前，进行区域性和地方性抗生素敏感性测试，以及开发新一代的四环素类药物，以防止抗生素滥用、耐药菌株的出现和传播，以及最终治疗失败，都是非常重要和必要的。
