Piñeiro Luis, Idigoras Pedro, Arrastia Maitane, Manzanal Ayla, Ansa Iñigo, Cilla Gustavo
Microbiology Department, Donostia University Hospital, 20014 Donostia, Spain.
Biodonostia Health Research Institute, 20014 Donostia, Spain.
Antibiotics (Basel). 2022 Oct 27;11(11):1492. doi: 10.3390/antibiotics11111492.
The management of Mycoplasma genitalium sexually transmitted infection (STI) is hindered by increasing resistance to the recommended antibiotics, macrolides and quinolones, worldwide. In Gipuzkoa (Basque Country, Spain), macrolide and quinolone resistance rates in 2014−2018 were reported as <20% and <10%, respectively. The aims of this study were to compare these rates with those in 2019−2021 and analyse the genetic and epidemiological features of the strains and cases associated with striking changes in the resistance trends. Resistance to macrolides (n = 1019) and quinolones (n = 958) was studied, analysing mutations in 23S rRNA and parC/gyrA genes, respectively. The rate of macrolide resistance increased from 17.3% in 2014−2018 to 32.1% in 2019−2021, as much in the more prevalent A2058/2059G mutations (16.6−27.8%) as in the emergent A2058T mutations (0.5−4.1%) but with differences in the odds ratios and the relative risk increase between A2058T and A2058/2059G mutations. MG191 adhesin and MG309 lipoprotein of the 27 emergent strains detected with A2058T mutations were amplified, sequenced, and typed using phylogenetic and variable number tandem repeat analysis, respectively. Genetic clonal spread was ruled out, but most of the A2058T cases were men who had sex with men (24/27) with a history of STI and antibiotic treatments (19/27). No changes were observed in quinolone resistance trends, but the rate of resistance to both antibiotics rose from 2.9% to 8.3%, especially in cases with A2058T mutations. The genetic characterisation of strains and epidemiological surveillance of cases are needed to detect populations at increased risk of treatment failure in this infection.
全球范围内，对推荐使用的抗生素（大环内酯类和喹诺酮类）耐药性的增加阻碍了生殖支原体性传播感染（STI）的管理。在吉普斯夸省（西班牙巴斯克地区），2014 - 2018年大环内酯类和喹诺酮类的耐药率分别报告为<20%和<10%。本研究的目的是将这些耐药率与2019 - 2021年的耐药率进行比较，并分析与耐药趋势显著变化相关的菌株和病例的遗传及流行病学特征。分别研究了对大环内酯类（n = 1019）和喹诺酮类（n = 958）的耐药情况，分析了23S rRNA和parC/gyrA基因中的突变。大环内酯类耐药率从2014 - 2018年的17.3%上升至2019 - 2021年的32.1%，在更常见的A2058/2059G突变（16.6 - 27.8%）和新出现的A2058T突变（0.5 - 4.1%）中均如此，但A2058T和A2058/2059G突变在优势比和相对风险增加方面存在差异。对检测到的27株携带A2058T突变的新出现菌株的MG191黏附素和MG309脂蛋白分别进行了扩增、测序，并使用系统发育分析和可变数目串联重复分析进行分型。排除了基因克隆传播，但大多数携带A2058T突变的病例是有性传播感染病史和接受过抗生素治疗的男男性行为者（24/27）。喹诺酮类耐药趋势未观察到变化，但对两种抗生素的耐药率从2.9%上升至8.3%，尤其是在携带A2058T突变的病例中。需要对菌株进行基因特征分析和对病例进行流行病学监测，以检测该感染中治疗失败风险增加的人群。
