Fox-Lewis Shivani, Forster Rose, Basu Indira, Blakiston Matthew, McAuliffe Gary
Department of Microbiology, LabPlus, Auckland City Hospital, Auckland, New Zealand.
Auckland Sexual Health Service, Auckland, New Zealand; and University of Auckland, Auckland, New Zealand.
Sex Health. 2024 Dec;21. doi: 10.1071/SH24166.
Background New Zealand has among the highest rates of antimicrobial resistance in Mycoplasma genitalium in the world. The aim of this study was to correlate treatment outcomes with 23S rRNA and parC mutations associated with macrolide and fluroquinolone resistance, respectively, in a cohort of sexual health clinic patients. Methods Laboratory and clinical data were collected for patients with M. genitalium infections attending Auckland Sexual Health Service between 1 January 2018 and 31 December 2022, who had a test-of-cure performed within 21-90days of a treatment episode. Treatment outcomes were correlated with the presence or absence of resistance mutations and treatment regimen utilised. Results A total of 95 infections from 93 patients met the study inclusion criteria. Eighty of 93 (86%) infections with available data were macrolide resistant, with 20 of 74 (27%) having both macrolide resistance and parC mutations. Sixteen of 20 (80%) of parC mutations were G248T (S83I), three of 20 (15%) G259T (D87Y) and one of 20 (5%) A247C (S83R). All macrolide-susceptible infections treated with doxycycline and azithromycin were cured (12/12), as were all macrolide-resistant infections without parC mutations treated with doxycycline and moxifloxacin (37/37). Cure rates for macrolide-resistant infections with parC mutations were lower, with variable and often multiple treatment courses; eight of 16 (50%) were cured using one course of sequential doxycycline and moxifloxacin, seven of nine (78%) with one course of minocycline, zero of two (0%) with pristinamycin and one of one (100%) with doxycycline and sitafloxacin. Conclusions Our findings highlight the differing treatment outcomes for infections with and without parC mutations, offering opportunities to refine management of M. genitalium infections.
新西兰的生殖支原体抗菌药物耐药率位居世界前列。本研究旨在探讨性健康诊所的一组患者中，治疗结果与分别与大环内酯类和氟喹诺酮类耐药相关的23S rRNA和parC突变之间的相关性。方法：收集2018年1月1日至2022年12月31日在奥克兰性健康服务中心就诊的生殖支原体感染患者的实验室和临床数据，这些患者在治疗后21至90天内进行了治愈检测。将治疗结果与耐药突变的有无以及所采用的治疗方案相关联。结果：93例患者的95次感染符合研究纳入标准。93例中有数据的感染中，80例（86%）对大环内酯类耐药，74例中有20例（27%）同时存在大环内酯类耐药和parC突变。20例parC突变中，16例（80%）为G248T（S83I），3例（15%）为G259T（D87Y），1例（5%）为A247C（S83R）。所有用多西环素和阿奇霉素治疗的大环内酯类敏感感染均治愈（12/12），所有用多西环素和莫西沙星治疗的无parC突变的大环内酯类耐药感染也均治愈（37/37）。有parC突变的大环内酯类耐药感染的治愈率较低，治疗疗程多样且常为多个疗程；16例中有8例（50%）采用一个疗程的序贯多西环素和莫西沙星治愈，9例中有7例（78%）采用一个疗程的米诺环素治愈，2例中有0例（0%）采用普那霉素治愈，1例中有1例（100%）采用多西环素和西他沙星治愈。结论：我们的研究结果突出了有和没有parC突变的感染在治疗结果上的差异，为优化生殖支原体感染的管理提供了机会。
