Hakre Shilpa, Sanders-Buell Eric, Casimier Rosemary O, O'Sullivan Anne Marie, Peel Sheila A, Tovanabutra Sodsai, Scott Paul T, Okulicz Jason F
Emerging Infectious Diseases Branch, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
United States Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
Open Forum Infect Dis. 2024 Jul 15;11(7):ofae407. doi: 10.1093/ofid/ofae407. eCollection 2024 Jul.
(MG) infection is a public health concern due to antimicrobial resistance (AMR). Data are limited on repeat MG infection and AMR among US Air Force service members with HIV.
US Air Force service members seeking HIV care were screened for MG infection during the surveillance period (16 May 2016-16 March 2020). Baseline and repeat MG prevalence rates were estimated. An extended Cox proportional hazards regression model evaluated characteristics associated with repeat MG infection. MG-positive rectal samples were tested for macrolide or fluoroquinolone resistance.
Among 299 male patients from a total of 308 patients followed during the surveillance period, baseline prevalence of MG infection was 19.7% (n = 59); among the 101 patients who screened positive for MG at any time during the surveillance period, repeat MG was 35% (n = 36). Characteristics independently associated with increased risk of repeat infection were sexually transmitted infection history vs none (adjusted hazard ratio [aHR], 2.33; 95% CI, 1.26-4.31), a sexually transmitted infection coinfection vs no positive test result in the medical records (aHR, 5.13; 95% CI, 2.78-9.49), and a new HIV diagnosis (<1 vs ≥1 year; aHR, 2.63; 95% CI, 1.45-3.73). AMR in MG-positive rectal specimens was 88% (43/49) indicating macrolide resistance, 18% (10/56) quinolone resistance, and 18% (10/56) both.
Macrolide and fluoroquinolone resistance mutations were common. Testing for co-occurring MG infection and AMR mutations may be warranted in guiding treatment for sexually transmitted infections such as chlamydia or gonorrhea detected at HIV diagnosis.
由于抗菌药物耐药性（AMR），支原体（MG）感染成为一个公共卫生问题。关于美国空军感染HIV的服役人员中MG重复感染和AMR的数据有限。
在监测期（2016年5月16日至2020年3月16日）对寻求HIV护理的美国空军服役人员进行MG感染筛查。估计基线和重复MG感染率。采用扩展的Cox比例风险回归模型评估与MG重复感染相关的特征。对MG阳性的直肠样本进行大环内酯类或氟喹诺酮类耐药性检测。
在监测期内随访的308例患者中的299例男性患者中，MG感染的基线感染率为19.7%（n = 59）；在监测期内任何时间MG筛查呈阳性的101例患者中，MG重复感染率为35%（n = 36）。与重复感染风险增加独立相关的特征包括有性传播感染病史与无病史（调整后风险比[aHR]，2.33；95%CI，1.26 - 4.31）、有性传播感染合并感染与病历中无阳性检测结果（aHR，5.13；95%CI，2.78 - 9.49）以及新的HIV诊断（<1年与≥1年；aHR，2.63；95%CI，1.45 - 3.73）。MG阳性直肠样本中的AMR情况为88%（43/49）表明大环内酯类耐药，18%（10/56）喹诺酮类耐药，18%（10/56）两者均耐药。
大环内酯类和氟喹诺酮类耐药突变很常见。在指导对HIV诊断时检测到的衣原体或淋病等性传播感染的治疗中，对同时存在的MG感染和AMR突变进行检测可能是必要的。
