Antibiotic Resistance and Genotypes of Mycoplasma genitalium during a Resistance-Guided Treatment Regime in a German University Hospital

Abstract

The treatment of infections from the sexually transmitted pathogen Mycoplasma genitalium is hampered by the rapidly increasing resistance to the recommended first- (macrolides) and second-line antibiotics (quinolones). Thus, resistance-guided therapy (RGT) is key for its successful eradication but the efficiency of this approach can be influenced by re-infections and treatment failures. The typing of strains is helpful to distinguish between ongoing colonization, re-infection or the development of resistance. In the present study, mgpB and MG_309 types as well as mutations associated with macrolide, quinolone and tetracycline resistance of strains in M. genitalium-positive samples accumulated in the years 2019 and 2020 at a university hospital were analyzed. Fifty-eight positive first and sixteen positive follow-up samples from patients (96.6% male, 84.5% men who have sex with men, 74.1% HIV-positive) were included. Twenty-three mgpB types (seven new types), nine MG_309 types and thirty-four mgpB/MG_309 types were identified. The prevalence of mutations associated with macrolide, quinolone and tetracycline resistance was 56.9%, 10.3% and 6.8%, respectively. Despite the fact that many asymptomatic patients were not treated and tests of cure were impossible in different cases, the preliminary rate of successful eradication (93.3%) in this study is promising for the continuation of the RGT strategy.

Retrospective Analysis of Ugandan Men with Urethritis Reveals Mycoplasma genitalium and Associated Macrolide Resistance

“…In comparison to the prevalence of macrolide resistance in other countries, which can be as high as 80% ( 33 – 35 ), our data suggest that macrolide resistance is emerging in Uganda, which is not surprising considering the lack of antimicrobial stewardship and high rates of antimicrobial-resistant gonorrhea ( 25 ). Although the number of macrolide-resistant M. genitalium infections in our study was small ( n = 3), they were more common in MSM than in MSW, which is consistent with previous reports ( 36 , 37 ).…”

Molecular Tools for Typing Mycoplasma pneumoniae and Mycoplasma genitalium

“…It remains unclear whether this is a result of the widespread occurrence of this type in a relatively self-contained sexual network ( Fernandez-Huerta et al, 2020b ) and/or of a selection advantage in the rectal microenvironment ( Guiraud et al, 2021 ). Despite the high discriminatory power of mgpB typing, future spread of distinct types in particular populations might require an increased use of the MG_309 method for successful differentiation (e.g., for comparison of first samples and a positive test of cure; Pineiro et al, 2019 ; Dumke et al, 2020 ; Dumke and Spornraft-Ragaller, 2021 ). In addition, type 4 strains have been found to be macrolide resistant in many cases.…”

“…Further studies should analyze if these differences or potential conformation changes of MgpB after recombination events in strains with constant mgpB type will have an influence on pathogenesis ( Wood et al, 2020 ). Examples of long-term colonization of patients with the same type ( Hjorth et al, 2006 ; Dumke et al, 2020 ; Dumke and Spornraft-Ragaller, 2021 ) and the non-reactivity of the conserved N-terminus with antibodies from infected animals ( Iverson-Cabral et al, 2015 ) may suggest that the typing region of MgpB is of limited importance for interaction with the host immune system.…”

“…The corresponding DI’s for mgpB sequencing in different studies varied between 0.82 and 0.99 whereas MG_309 typing resulted in discrimination between 0.84 and 0.95. Lower DI’s seem to be associated with the investigation of more local than national populations ( Dumke et al, 2020 ; Dumke and Spornraft-Ragaller, 2021 ), indicating a lower number of circulating genotypes. DI’s of ≥0.95 were obtained after the mgpB and MG_309 methods were combined.…”

Molecular Characterization and Detection of Macrolide and Fluoroquinolone Resistance Determinants in Mycoplasma genitalium in South Africa, 2015 to 2018

“…Polymerase chain reaction amplification and sequencing of 281 bp of the MG191 semiconserved region was performed using the MgPa-1/MgPa-3 primer set 10 . A sequence type (ST) was assigned by comparing the MG191 sequences obtained in this study with a comprehensive global MG191 ST database containing 237 STs created by Dumke and Spornraft-Ragaller 16 (Table S1, http://links.lww.com/OLQ/A813). A dendrogram was generated to visualize the relationship between M. genitalium strains using the unweighted pair-group method with arithmetic mean.…”