台湾高危人群中支原体属生殖器感染及大环内酯类和氟喹诺酮类药物耐药相关突变。
Mycoplasma genitalium infection and resistance-associated mutations to macrolides and fluoroquinolones among high-risk patients in Taiwan.
机构信息
Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
出版信息
J Microbiol Immunol Infect. 2024 Aug;57(4):629-637. doi: 10.1016/j.jmii.2024.05.004. Epub 2024 May 11.
BACKGROUND
Mycoplasma genitalium is an emerging etiology of sexually transmitted infections (STIs) with increasing resistance to antimicrobials. Surveillance on the epidemiology of M. genitalium infection and antimicrobial resistance is warranted.
METHODS
Between September 2021 and August 2023, people with HIV (PWH) and people without HIV (PWoH) at risk of STIs were screened for M. genitalium infection using a multiplex polymerase-chain-reaction assay of specimens collected from the rectum, urethra, oral cavity, and vagina. The prevalences of resistance-associated mutations (RAMs) of M. genitalium to fluoroquinolones, macrolides, and tetracycline were investigated.
RESULTS
During the 2-year study period, 1021 participants were enrolled, including 531 PWH and 490 PWoH. Overall, 83 (8.1%) and 34 (7.6%) participants had M. genitalium infection at baseline and during follow-up, respectively, with the rectum being the most common site of detection (61.5%). With the first course of antimicrobial treatment, 27 of 63 (42.9%) participants with M. genitalium infection were cured during follow-up, including 24 of 58 (41.4%) who received doxycycline monotherapy. The prevalence of RAMs to macrolides, fluoroquinolones, and tetracyclines at baseline were 24.3%, 22.4%, and 7.9%, respectively. Though PWH had more M. genitalium infection (10.2% vs 5.9%, p = 0.01), a higher rate of RAMs to macrolides (41.0% vs 14.7%, p < 0.01) was found in PWoH.
CONCLUSIONS
Among high-risk populations, the prevalence of M. genitalium infection was 8.1%. The overall genotypic resistance of M. genitalium to macrolides and fluoroquinolones was moderately high in Taiwan. Detection of M. genitalium infection and antimicrobial resistance is warranted to ensure resistance-guided antimicrobial treatments to be administered.
背景
支原体生殖器是一种新兴的性传播感染（STI）病因，对抗微生物药物的耐药性不断增加。有必要对支原体生殖器感染和抗微生物药物耐药性进行监测。
方法
在 2021 年 9 月至 2023 年 8 月期间，对有感染艾滋病毒（HIV）的风险（HIV 阳性者，PWH）和无感染 HIV 的风险（HIV 阴性者，PWoH）的性传播感染高危人群进行了检测，使用直肠、尿道、口腔和阴道标本的多重聚合酶链反应检测支原体生殖器感染。调查了支原体生殖器对氟喹诺酮类、大环内酯类和四环素的耐药相关突变（RAMs）的流行情况。
结果
在 2 年的研究期间，共纳入了 1021 名参与者，其中 531 名 PWH 和 490 名 PWoH。总体而言，基线时有 83（8.1%）和随访时有 34（7.6%）参与者患有支原体生殖器感染，最常见的检测部位是直肠（61.5%）。在接受第一疗程的抗菌治疗后，随访期间有 27 名（63 名中的 42.9%）支原体生殖器感染患者被治愈，其中 24 名（58 名中的 41.4%）接受了多西环素单药治疗。基线时大环内酯类、氟喹诺酮类和四环素的 RAM 流行率分别为 24.3%、22.4%和 7.9%。虽然 PWH 的支原体生殖器感染率更高（10.2%比 5.9%，p=0.01），但在 PWoH 中发现大环内酯类的 RAM 率更高（41.0%比 14.7%，p<0.01）。
结论
在高危人群中，支原体生殖器感染的流行率为 8.1%。台湾支原体生殖器对大环内酯类和氟喹诺酮类的总体基因型耐药率较高。需要检测支原体生殖器感染和抗微生物药物耐药性，以确保进行耐药指导的抗微生物药物治疗。
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