AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan.
J Antimicrob Chemother. 2023 Aug 2;78(8):2070-2079. doi: 10.1093/jac/dkad208.
Mycoplasma genitalium has a tendency to develop macrolide and quinolone resistance.
We investigated the microbiological cure rate of a 7 day course of sitafloxacin for the treatment of rectal and urogenital infections in MSM.
This open-label, prospective cohort study was conducted at the National Center for Global Health and Medicine, Tokyo, Japan from January 2019 to August 2022. Patients with M. genitalium urogenital or rectal infections were included. The patients were treated with sitafloxacin 200 mg daily for 7 days. M. genitalium isolates were tested for parC, gyrA and 23S rRNA resistance-associated mutations.
In total, 180 patients (median age, 35 years) were included in this study, of whom 77.0% (97/126) harboured parC mutations, including 71.4% (90/126) with G248T(S83I) in parC, and 22.5% (27/120) harboured gyrA mutations. The median time to test of cure was 21 days. The overall microbiological cure rate was 87.8%. The cure rate was 100% for microbes harbouring parC and gyrA WTs, 92.9% for microbes harbouring parC G248T(S83I) and gyrA WT, and 41.7% for microbes harbouring parC G248T(S83I) and gyrA with mutations. The cure rate did not differ significantly between urogenital and rectal infection (P = 0.359).
Sitafloxacin monotherapy was highly effective against infection caused by M. genitalium, except strains with combined parC and gyrA mutations. Sitafloxacin monotherapy can be used as a first-line treatment for M. genitalium infections in settings with a high prevalence of parC mutations and a low prevalence of gyrA mutations.
支原体生殖器具有发展大环内酯类和喹诺酮类耐药性的倾向。
我们研究了西他沙星 7 天疗程治疗男男性行为者直肠和泌尿生殖道感染的微生物学治愈率。
这项开放标签、前瞻性队列研究于 2019 年 1 月至 2022 年 8 月在日本东京的国家全球卫生与医学中心进行。纳入患有支原体生殖器泌尿生殖道或直肠感染的患者。患者接受西他沙星 200mg 每日 1 次，共 7 天治疗。检测支原体生殖器分离株 parC、gyrA 和 23S rRNA 耐药相关突变。
本研究共纳入 180 例患者（中位年龄 35 岁），其中 77.0%（97/126）携带 parC 突变，包括 71.4%（90/126）的 parC 中的 G248T(S83I)和 22.5%（27/120）的 gyrA 突变。检测治愈的中位时间为 21 天。总的微生物学治愈率为 87.8%。携带 parC 和 gyrA WT 的微生物的治愈率为 100%，携带 parC G248T(S83I)和 gyrA WT 的微生物的治愈率为 92.9%，携带 parC G248T(S83I)和 gyrA 突变的微生物的治愈率为 41.7%。泌尿生殖道和直肠感染的治愈率无显著差异（P=0.359）。
西他沙星单药治疗对支原体生殖器感染非常有效，除了同时携带 parC 和 gyrA 突变的菌株。在 parC 突变流行率高且 gyrA 突变流行率低的情况下，西他沙星单药治疗可作为支原体生殖器感染的一线治疗。
