Detection and Prevalence of Macrolide and Fluoroquinolone Resistance in Mycoplasma genitalium in Badalona, Spain

Abstract

Macrolide and fluoroquinolone resistance (MLr/FQr) in Mycoplasma genitalium (MG) infections is concerning worldwide. Current guidelines recommend performing MLr detection in MG-positive cases to adjust antimicrobial therapy. We aimed to evaluate the usefulness of PCR followed by pyrosequencing for MLr detection in comparison with a one-step commercial assay and to assess the prevalence of MLr and FQr in Badalona, Spain. A total of 415 MG-positive samples by Allplex STI-7 (Seegene) were analyzed for MLr detection by pyrosequencing. From those, 179 samples were further analyzed for MG and MLr by ResistancePlus® MG kit (SpeeDx) and 100 of them also for fluoroquinolone resistance (FQr) by sequencing the parC gene. Regarding MG detection, Allplex and Resistance Plus® showed an overall agreement of 87%, but this value rose to 95.4% if we compare them for MLr detection. Prevalence of MLr was 23.1% in Badalona, but this rate increased to 73.7% in the HIV-positive patients cohort. FQr detection showed 3% of resistant strains. Pyrosequencing is a convenient and cheap technique for MLr detection, but one-step tools should be considered in high-throughput laboratories. Despite the fact that MLr remained moderate and FQr was low in our study, simultaneous MG and MLr detection would improve patient’s management applying resistance-guided treatment strategies.

Epidemiology and prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium in a tertiary hospital from Madrid, Spain

“…In our studio, a higher percentage of mutation A2058T macrolide resistance-associated was detected than in other series which the A2058G or A2059G mutations are the most frequent detected [6][7][8]. A higher prevalence of the A2058T mutation was also reported by Asenjo et…”

“…According to other studies, the highest prevalence of MG in HULP was detected in males of sexually active age. In our study, we found a higher prevalence of resistances to macrolides and fluoroquinolones than in other areas of Spain [6][7][8][9]. However, we have not found any predominant resistance mutations in patients with any STCs.…”

“…Studies reported in other areas of Spain showed a prevalence of macrolides resistance in MG of around 25-30% [6][7][8][9]. These data may be biased between studies by the overall number of patients screened for MG, the number of MG strains tested, the clinical patient condition or the use of macrolides in each health area.…”

“…In relation to fluoroquinolones resistance, there are few data available due to the short time of commercial kits have been on the market. In some studies from Spain, the prevalence of MARF is reported around 10% [ 6 , 7 , 8 ]. Our data shows a higher prevalence, however the number of strains tested was low (n=10) to infer globally in our population.…”

“…In recent years, there has been an increase in MG resistances reported in different countries worldwide [5]. The prevalence of mutations associated with resistance to macrolides (MARM) or fluoroquinolones (MARF) contrasts between series depending of the local epidemiology [6][7][8][9]. A meta-analysis estimated the overall prevalence of MARM and MARF at 19% and 3.5% respectively, and dual resistance at 2% in Spain [5].…”