Mateo León C, García Martínez de Artola D, Pino-Calm B
Cristian Mateo León. Servicio de Microbiología y Parasitología Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain.
Rev Esp Quimioter. 2023 Aug;36(4):416-420. doi: 10.37201/req/014.2023. Epub 2023 May 8.
Mycoplasma genitalium (MG) is a recognized sexually transmitted pathogen. Increasing resistance to main lines of treatment (macrolides and quinolones) justifies a genetic study of mutations to improve cure rates.
A total of 8,508 samples from April 2018 to July 2022 were processed using AllplexTM STI Essential Assay. In MG positive cases 23S rRNA V domain, gyrA and parC genes were studied. Mutations detected were checked to assess their clinical significance and medical records were reviewed to obtain demographic and treatment information.
Resistance study was performed on 92 samples (65 men and 27 women). In relation to the genotypic study, 28 patients presented mutations to macrolides (30.43%). Most common was A2059G (18.48%). For quinolones, 5 patients (5.43%) had clinically relevant mutations in parC gene. Of note was a patient with G295 mutation in gyrA associated with G248T in parC. Thirty subjects underwent a test of cure (TOC). Azithromycin was the most common empirical regimen and moxifloxacin the main alternative.
High rate of resistance in our environment evidences the need for targeted therapy by genotypic study of macrolide resistance, supported by the detection of mutations in parC and gyrA to predict quinolones susceptibility and the use of TOC to evaluate treatment response.
生殖支原体（MG）是一种公认的性传播病原体。对主要治疗药物（大环内酯类和喹诺酮类）的耐药性不断增加，这使得对突变进行基因研究以提高治愈率成为必要。
使用Allplex™ STI Essential检测法对2018年4月至2022年7月期间的8508份样本进行处理。对MG阳性病例研究23S rRNA V结构域、gyrA和parC基因。检查检测到的突变以评估其临床意义，并查阅病历以获取人口统计学和治疗信息。
对92份样本（65名男性和27名女性）进行了耐药性研究。关于基因型研究，28名患者出现了对大环内酯类的突变（30.43%）。最常见的是A2059G（18.48%）。对于喹诺酮类，5名患者（5.43%）在parC基因中有临床相关突变。值得注意的是一名患者，其gyrA基因中的G295突变与parC基因中的G248T相关。30名受试者接受了治愈测试（TOC）。阿奇霉素是最常见的经验性治疗方案，莫西沙星是主要替代药物。
我们环境中的高耐药率表明，需要通过对大环内酯类耐药性的基因型研究进行靶向治疗，通过检测parC和gyrA中的突变来预测喹诺酮类药物的敏感性，并使用TOC来评估治疗反应。
