Maduna L D, Peters R P H, Kingsburgh C, Strydom K-A, Kock M M
Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, South Africa; Department of Biology, Faculty of Science and Technology, National University of Lesotho, Maseru, Lesotho.
S Afr Med J. 2021 Oct 5;111(10):995-997. doi: 10.7196/SAMJ.2021.v111i10.15714.
Reports have emerged globally of antimicrobial resistance (AMR) in Neisseria gonorrhoeae and Mycoplasma genitalium infections. In South Africa (SA), there are substantial differences between private and public healthcare with regard to antimicrobial drug prescribing practice, which could affect AMR patterns of private and public healthcare patients.
To perform a pilot study to determine the frequency of AMR of N. gonorrhoeae and M. genitalium in patients accessing SA's private healthcare sector.
In this cross-sectional study, N. gonorrhoeae-positive cultures and M. genitalium DNA samples were collected from a private healthcare reference laboratory from August 2018 to August 2019. In N. gonorrhoeae-positive cultures, antimicrobial susceptibility testing was performed, followed by N. gonorrhoeae multiantigen sequence typing (NG-MAST) to determine genetic relatedness of the isolates. To determine macrolide and fluoroquinolone resistance rates, M. genitalium-positive samples were analysed by sequencing the 23S rRNA, gyrA and parC genes.
Twenty-one N. gonorrhoeae- and 27 M. genitalium-positive specimens were included in this analysis. High rates of resistance were detected among gonococcal isolates, with 90% resistance to tetracycline, 86% to penicillin and 62% to ciprofloxacin, but no resistance to azithromycin, cefixime and ceftriaxone. NG-MAST revealed genetically diverse isolates with 83% novel NG-MAST sequence types. Macrolide and fluoroquinolone resistance-associated mutations were detected in 18.5% (n=5/27) and 7.4% (n=2/27) of M. genitalium strains, respectively.
We observed high frequencies of ciprofloxacin, penicillin and tetracycline resistance in N. gonorrhoeae and macrolide resistance-associated mutations in M. genitalium in private healthcare sector patients in SA. This finding highlights the need to use diagnostics for sexually transmitted infections and to include the private healthcare sector in antimicrobial surveillance and stewardship programmes.
全球范围内已出现淋病奈瑟菌和生殖支原体感染的抗菌药物耐药性（AMR）报告。在南非，私立医疗保健机构和公立医疗保健机构在抗菌药物处方实践方面存在很大差异，这可能会影响私立和公立医疗保健患者的AMR模式。
开展一项试点研究，以确定在南非私立医疗保健部门就诊的患者中淋病奈瑟菌和生殖支原体的AMR频率。
在这项横断面研究中，于2018年8月至2019年8月从一家私立医疗保健参考实验室收集淋病奈瑟菌阳性培养物和生殖支原体DNA样本。对淋病奈瑟菌阳性培养物进行抗菌药物敏感性测试，随后进行淋病奈瑟菌多抗原序列分型（NG-MAST）以确定分离株的遗传相关性。为了确定大环内酯类和氟喹诺酮类耐药率，通过对23S rRNA、gyrA和parC基因进行测序来分析生殖支原体阳性样本。
本分析纳入了21份淋病奈瑟菌阳性和27份生殖支原体阳性标本。在淋球菌分离株中检测到高耐药率，对四环素的耐药率为90%，对青霉素为86%，对环丙沙星为62%，但对阿奇霉素、头孢克肟和头孢曲松无耐药。NG-MAST显示分离株具有遗传多样性，83%为新型NG-MAST序列类型。分别在18.5%（n = 5/27）和7.4%（n = 2/27）的生殖支原体菌株中检测到与大环内酯类和氟喹诺酮类耐药相关的突变。
我们在南非私立医疗保健部门的患者中观察到淋病奈瑟菌对环丙沙星、青霉素和四环素的高耐药频率以及生殖支原体中与大环内酯类耐药相关的突变。这一发现凸显了使用性传播感染诊断方法以及将私立医疗保健部门纳入抗菌监测和管理计划的必要性。
