Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, Netherlands.
Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, Netherlands
BMJ Open. 2022 Dec 7;12(12):e066368. doi: 10.1136/bmjopen-2022-066368.
This study aimed to determine the prevalence of fluoroquinolone resistance-associated mutations (QRAMs) in (MG) among clients of two sexual health centres (SHCs) in the Netherlands.
A cross-sectional study.
Between 2018 and 2019, 669 clients with MG were included from two previous studies: 375 male clients with urethritis from the SHC in Amsterdam; and 294 clients (male and female) from the SHC in Amsterdam and The Hague. Urogenital and anal samples (705 in total) that tested positive for MG by nucleic acid amplification tests were selected.
The presence of QRAM was detected by an MG-QRAM PCR targeting four mutations in the gene and investigated by sequence analysis of relevant regions of the and genes. Possible risk factors for the presence of QRAM were investigated.
We found QRAM in 58 of 669 (9%) clients with an MG infection: 36 of 375 (10%) in the study population of men with urethritis and 22 of 294 (7%) in the study population of other clients (including both men and women; p=0.334). Most prevalent mutations in the gene were S83I and D87N, occurring in 31 of 60 (52%) and 20 of 60 (33%) samples, respectively. Factors associated with the presence of QRAM were: men who have sex with men (adjusted OR (aOR) 3.4, 95% CI 1.7 to 6.9) and Asian origin (aOR 2.5, 95% CI 1.2 to 5.6). Multidrug resistance (QRAM plus macrolide resistance-associated mutations) was found in 46 of 669 (7%) clients.
Nine per cent of MG-positive clients from two Dutch SHCs had QRAM. New treatment strategies and antibiotics are needed to treat symptomatic patients with multidrug-resistant MG.
本研究旨在确定荷兰两家性健康中心（SHC）的淋病奈瑟菌（MG）中氟喹诺酮耐药相关突变（QRAM）的流行率。
横断面研究。
2018 年至 2019 年，从两项先前的研究中纳入了 669 名 MG 阳性患者：阿姆斯特丹 SHC 的 375 名男性尿道炎患者；以及阿姆斯特丹和海牙 SHC 的 294 名男性和女性患者（共 705 例）。选择经核酸扩增试验检测 MG 阳性的泌尿生殖道和肛门样本。
通过针对 基因中的四个突变的 MG-QRAM PCR 检测 QRAM 的存在，并对 基因和 基因的相关区域进行序列分析。调查了 QRAM 存在的可能危险因素。
我们发现 669 名 MG 感染患者中有 58 名（9%）存在 QRAM：尿道炎患者研究人群中 36 名（10%），其他患者研究人群中 22 名（包括男性和女性；p=0.334）。 基因中最常见的突变是 S83I 和 D87N，分别发生在 60 个样本中的 31 个（52%）和 20 个（33%）样本中。与 QRAM 存在相关的因素包括：男男性行为者（调整后的比值比（aOR）3.4，95%CI 1.7 至 6.9）和亚洲血统（aOR 2.5，95%CI 1.2 至 5.6）。在 669 名患者中发现了 46 名（7%）多药耐药（QRAM 加大环内酯类耐药相关突变）患者。
两家荷兰 SHC 的 9%的 MG 阳性患者存在 QRAM。需要新的治疗策略和抗生素来治疗多药耐药性 MG 的有症状患者。
