Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at a STI Clinic in Guangzhou, China, 2016-2018

Abstract

Background Antimicrobial resistance in M. genitalium is a growing clinical problem. We investigated the mutations associated with macrolide and fluoroquinolone resistance, two commonly used medical regimens for treatment in China. Our aim is to analyze the prevalence and diversity of mutations among M. genitalium-positive clinical specimens in Guangzhou, south China. Methods A total of 154 stored M. genitalium positive specimens from men and women attending a STI clinic were tested for macrolide and fluoroquinolone mutations. M. genitalium was detected via TaqMan MGB real-time PCR. Mutations associated with macrolide resistance were detected using primers targeting region V of the 23S rRNA gene. Fluoroquinolone resistant mutations were screened via primers targeting topoisomerase IV (parC) and DNA gyrase (gyrA). Results 98.7% (152/154), 95.5% (147/154) and 90.3% (139/154) of M. genitalium positive samples produced sufficient amplicon for detecting resistance mutations in 23S rRNA, gyrA and parC genes, respectively. 66.4% (101/152), 0.7% (1/147) and 77.7% (108/139) samples manifested mutations in 23S rRNA, gyrA and parC genes, respectively. A2072G (59/101, 58.4%) and S83I (79/108, 73.1%) were highly predominating in 23S rRNA and parC genes, respectively. Two samples had amino acid substitutions in gyrA (M95I and A96T, respectively). Two samples had two amino acid substitutions in parC (S83I + D87Y). 48.6% (67/138) of samples harbored both macrolide and fluoroquinolone resistance-associated mutations. The most common combination of mutations was A2072G (23S rRNA) and S83I (parC) (40/67, 59.7%). One sample had three amino acid changes in 23S rRNA, gyrA and parC genes (A2072G + A96T + S83I). Conclusions The high antimicrobial resistance rate of M. genitalium in Guangzhou is a very worrying problem and suggests that antimicrobial resistance testing and the development of new antibiotic regimens are crucially needed.

Prevalence of fluoroquinolone resistance-associated mutations inMycoplasma genitaliumamong clients of two sexual health centres in the Netherlands: a cross-sectional study

“… 22 Yet, Asian origin has not been identified as a risk factor before. Nonetheless, the prevalence of QRAM in Japan, 11 Singapore 24 and China 25 is much higher than in Europe. Travelling to a country with a high prevalence of QRAM or having sex with a person from such a country might be a risk factor for QRAM.…”

2021 CDC Update: Treatment and Complications of Sexually Transmitted Infections (STIs)

“…The U.S. Food and Drug Administration (FDA) approved such testing in early 2019 [51][52][53]. Unfortunately, recent research has identified various genetic mutations in M. genitalium that result in antimicrobial resistance (AMR) [54][55][56][57]. The prevalence of mutations in the 23S rRNA gene (which allow for macrolide resistance) seems to be increasing worldwide, and more rapidly than topoisomerase/gyrase mutations (parC/gyrA) (which provide fluoroquinolone resistance) [58,59].…”

Molecular mechanisms of macrolide and fluoroquinolone resistance among Korean isolates of Mycoplasma genitalium over a period of five years 2014–2019

“…In Japan, the prevalence increased from 4.8 % before 2010–28.7 % in 2016–2017. In contrast, the prevalence was the lowest in Europe (2.8 %) [10–12]. In addition, M.…”