Department of Medicine, 12190Brighton and Sussex Medical School, Brighton, UK.
Department of Microbiology and Infection, 1949Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Int J STD AIDS. 2021 Jul;32(8):758-765. doi: 10.1177/0956462420987764. Epub 2021 Mar 23.
We evaluated the ResistancePlus® MG assay in providing macrolide resistance-guided treatment (RGT) for infection at a UK sexual health centre. -positive samples from men with urethritis and women with pelvic inflammatory disease (PID) were tested for macrolide resistance-mediating mutations (MRMMs). MRMM-positive infections were given moxifloxacin 400 mg; otherwise 2 g azithromycin (1 g single dose and then 500 mg OD) was given. Among 57 -positive patients (32 men and 25 women), MRMMs were detected in 41/57 (72% [95% confidence interval (95% CI) 58-83%). Thirty-two of 43 patients given RGT attended for test of cure. Treatment failure rate was significantly lower at 1/32 (3%) than 10/37 (27%) before RGT ( = 37 [men = 23 and women = 17]; = 0.008). Treatment failure was lower in male urethritis (0/15 vs. 7/21 = 0.027) but not in female PID. There was a trend of a shorter time to negative test of cure (TOC) in male urethritis (55.1 [95% 43.7-66.4] vs. 85.1 [95% CI CI 64.1-106.0] days, = 0.077) but not in female PID. Macrolide resistance is higher than previous UK reports and higher than expected. RGT reduces overall treatment failure and is particularly beneficial in urethritis. Fluoroquinolone resistance will continue to rise with increasing fluoroquinolone use, and RGT is critical to direct appropriate azithromycin use and prevent overuse of moxifloxacin.
我们在英国一家性健康中心评估了 ResistancePlus® MG 检测对于 感染的大环内酯类药物耐药指导治疗（RGT）的效果。对来自尿道炎男性和盆腔炎（PID）女性的 阳性样本进行了大环内酯类药物耐药相关突变（MRMMs）检测。MRMM 阳性感染使用莫西沙星 400mg；否则给予 2g 阿奇霉素（单次 1g，然后 500mg 每天）。在 57 例 阳性患者（32 名男性和 25 名女性）中，在 41/57（72%[95%置信区间（95%CI）58-83%]）例中检测到 MRMMs。在接受 RGT 的 43 例患者中，有 32 例接受了治愈检测。治疗失败率显著低于 RGT 前的 10/37（27%）（ = 37[男性=23，女性=17]； = 0.008）。男性尿道炎的治疗失败率较低（0/15 比 7/21 = 0.027），而女性 PID 则没有。男性尿道炎的阴性治愈检测时间（TOC）较短（55.1[95%CI 43.7-66.4]比 85.1[95%CI 64.1-106.0]天， = 0.077），但女性 PID 则没有。大环内酯类药物耐药率高于英国以往报道，也高于预期。RGT 降低了总体治疗失败率，对尿道炎尤其有益。随着氟喹诺酮类药物使用的增加，氟喹诺酮类药物耐药性将继续上升，RGT 对于指导合理使用阿奇霉素和防止莫西沙星过度使用至关重要。
