Department of Medicine, University of Washingtongrid.34477.33, Seattle, Washington, USA.
Statens Serum Institutgrid.6203.7, Copenhagen, Denmark.
J Clin Microbiol. 2021 Oct 19;59(11):e0081921. doi: 10.1128/JCM.00819-21. Epub 2021 Aug 18.
Mycoplasma genitalium is a sexually transmitted bacterium associated with nongonococcal urethritis (NGU) in men and cervicitis, endometritis, and pelvic inflammatory disease in women. Effective treatment is challenging due to the inherent, and increasingly acquired, antibiotic resistance in this pathogen. In our treatment trial conducted from 2007 to 2011 in Seattle, WA, we demonstrated poor efficacy of azithromycin (AZM) and doxycycline (DOX) against M. genitalium among men with NGU. In the present study, we cultured M. genitalium from 74 of 80 (92.5%) PCR-positive men at enrollment (V-1) and defined the MICs of AZM ( = 56 isolates) of DOX ( = 62 isolates). Susceptibility to AZM was bimodal; MICs were >8 μg/ml (44.6%) and <0.004 μg/ml (55.4%) for these isolates. The association of MIC with treatment efficacy was determined for men initially treated with either AZM ( = 30) or DOX ( = 24). Men treated with AZM were more likely to experience microbiologic treatment failure ( < 0.001) if infected with isolates that had AZM MICs of >8 μg/ml (18/18 men) than those with isolates that had AZM MICs of <0.004 μg/ml (1/12 men). Clinical treatment failure also was more likely to occur ( = 0.002) with AZM MICs of >8 μg/ml (12/18 men) than with AZM MICs of <0.004 μg/ml (1/12 men). In contrast, DOX MICs ranged from <0.125 to 2 μg/ml and were not correlated with microbiologic ( = 0.71) or clinical treatment ( = 0.41) failure, demonstrating no relationship between DOX MICs and treatment efficacy. Given the rapid spread of AZM resistance and the emergence of quinolone resistance, the current second-line therapy, monitoring MICs and evaluating other potential treatments for M. genitalium will be critical.
生殖支原体是一种性传播细菌，与男性非淋球菌性尿道炎（NGU）和女性宫颈炎、子宫内膜炎和盆腔炎有关。由于这种病原体固有的、且越来越多的抗生素耐药性，有效的治疗具有挑战性。在我们于 2007 年至 2011 年在西雅图进行的治疗试验中，我们证明了阿奇霉素（AZM）和强力霉素（DOX）对 NGU 男性中生殖支原体的疗效不佳。在本研究中，我们从 80 名 PCR 阳性男性中的 74 名（92.5%）入组时（V-1）培养了生殖支原体，并确定了 AZM（=56 株）和 DOX（=62 株）的 MIC。AZM 的敏感性呈双峰模式；这些分离株的 MIC 分别为>8μg/ml（44.6%）和<0.004μg/ml（55.4%）。对于最初用 AZM（=30 名）或 DOX（=24 名）治疗的男性，确定了 MIC 与治疗效果的关系。如果感染的分离株 AZM MIC 值>8μg/ml（18/18 名男性），则接受 AZM 治疗的男性更有可能出现微生物学治疗失败（<0.001），而 AZM MIC 值<0.004μg/ml（12/12 名男性）。AZM MIC 值>8μg/ml（18/18 名男性）也更有可能发生临床治疗失败（=0.002），而 AZM MIC 值<0.004μg/ml（12/12 名男性）。相比之下，DOX MIC 值范围为<0.125 至 2μg/ml，与微生物学（=0.71）或临床治疗（=0.41）失败无关，表明 DOX MIC 值与治疗效果之间没有关系。鉴于 AZM 耐药性的快速传播和喹诺酮类耐药性的出现，当前的二线治疗方法是监测 MIC 值并评估生殖支原体的其他潜在治疗方法将是至关重要的。
