生殖支原体对大环内酯类和氟喹诺酮类药物耐药性的演变模式：一项更新的系统评价和荟萃分析。
Evolving patterns of macrolide and fluoroquinolone resistance in Mycoplasma genitalium: an updated systematic review and meta-analysis.
作者信息
Chua Teck-Phui, Vodstrcil Lenka A, Murray Gerald L, Plummer Erica L, Jensen Jørgen S, Unemo Magnus, Chow Eric P F, Low Nicola, Whiley David M, Sweeney Emma L, Hocking Jane S, Danielewski Jennifer A, Garland Suzanne M, Fairley Christopher K, Zhang Lei, Bradshaw Catriona S, Machalek Dorothy A
机构信息
Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, VIC, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
出版信息
Lancet Microbe. 2025 Mar 24:101047. doi: 10.1016/j.lanmic.2024.101047.
BACKGROUND
Over the past 5 years, since publication of the initial review, studies have provided additional data on macrolide and fluoroquinolone resistance in Mycoplasma genitalium, including data from regions previously lacking this information. We aimed to provide contemporary estimates of macrolide and fluoroquinolone resistance in M genitalium to inform national, regional, and global treatment guidelines.
METHODS
This is an update of a previous systematic review and meta-analysis, which was performed up to Jan 7, 2019. In this update, we searched PubMed, Embase, and MEDLINE from Jan 1, 2018, to April 18, 2023, for published studies reporting macrolide, fluoroquinolone, or dual-class (macrolide and fluoroquinolone) resistance in M genitalium. Data were combined with the previous meta-analysis to examine resistance prevalence in M genitalium samples collected up to and including 2021. Random-effects meta-analyses were used to calculate summary estimates of prevalence. Subgroup analyses by WHO region and four time periods (before 2012 to 2018-21) were performed. This study was registered with PROSPERO, number CRD42021273340.
FINDINGS
166 studies (59 from the previous search period reporting data from M genitalium samples collected between 2003 and 2017, and 107 from the updated search period reporting data from M genitalium samples collected between 2005 and 2021) were included: 157 reporting macrolide resistance (41 countries; 22 974 samples), 89 reporting fluoroquinolone resistance (35 countries; 14 165 samples), and 74 reporting dual-class resistance (34 countries; 11 070 samples). In 2018-21, the overall prevalence of macrolide, fluoroquinolone, and dual-class resistance were 33·3% (95% CI 27·2-39·7), 13·3% (10·0-17·0), and 6·5% (4·0-9·4), respectively. Over time, there was a slight, although not statistically significant, decline in macrolide resistance in the Western Pacific and the Americas, but there was an increase in macrolide resistance in the European region. Fluoroquinolone resistance was highest in the Western Pacific and increased in the European non-Nordic region. ParC S83I was the most common variant associated with fluoroquinolone resistance, increasing from 0% (95% CI <0·0001-0·30) before 2012 to 7·3% (4·7-10·3) in 2018-21; p=0·055.
INTERPRETATION
Macrolide and fluoroquinolone resistance in M genitalium requires ongoing international surveillance, use of resistance assays for optimal antibiotic stewardship, and novel treatment options.
FUNDING
Australian Research Council.
背景
在过去5年里，自首次综述发表以来，多项研究提供了有关生殖支原体对大环内酯类和氟喹诺酮类耐药性的更多数据，包括来自以前缺乏此类信息地区的数据。我们旨在提供生殖支原体对大环内酯类和氟喹诺酮类耐药性的当代评估，以为国家、区域和全球治疗指南提供参考。
方法
这是对之前一项系统综述和荟萃分析的更新，之前的分析截至2019年1月7日。在本次更新中，我们检索了PubMed、Embase和MEDLINE数据库，检索时间为2018年1月1日至2023年4月18日，以查找报告生殖支原体对大环内酯类、氟喹诺酮类或双重耐药（大环内酯类和氟喹诺酮类）的已发表研究。将数据与之前的荟萃分析相结合，以研究截至2021年及包括2021年在内收集的生殖支原体样本中的耐药率。采用随机效应荟萃分析来计算患病率的汇总估计值。按世界卫生组织区域和四个时间段（2012年以前至2018 - 2021年）进行亚组分析。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42021273340。
结果
纳入了166项研究（59项来自之前检索期，报告了2003年至2017年收集的生殖支原体样本数据；107项来自更新检索期，报告了2005年至2021年收集的生殖支原体样本数据）：157项报告了大环内酯类耐药（41个国家；22974份样本），89项报告了氟喹诺酮类耐药（35个国家；14165份样本），74项报告了双重耐药（34个国家；11070份样本）。在2018 - 2021年，大环内酯类、氟喹诺酮类和双重耐药的总体患病率分别为33.3%（95%置信区间27.2 - 39.7）、13.3%（10.0 - 17.0）和6.5%（4.0 - 9.4）。随着时间推移，西太平洋地区和美洲的大环内酯类耐药率略有下降，尽管无统计学意义，但欧洲地区的大环内酯类耐药率有所上升。氟喹诺酮类耐药在西太平洋地区最高，且在欧洲非北欧地区有所增加。ParC S83I是与氟喹诺酮类耐药相关的最常见变异，从2012年以前的0%（95%置信区间<0.0001 - 0.30）增加到了2018 - 2021年的7.3%（4.7 - 10.3）；p = 0.055。
解读
生殖支原体对大环内酯类和氟喹诺酮类的耐药性需要持续进行国际监测，使用耐药性检测以优化抗生素管理，并探索新治疗方案。
资金来源
澳大利亚研究理事会。
Zotero 插件