HubMed - Alternative Health
Fluoroquinolone and macrolide resistance-associated mutations in Mycoplasma genitalium.
J Clin Microbiol. 2013 May 8;
Tagg KA, Jeoffreys NJ, Couldwell DL, Donald JA, Gilbert GL
Mycoplasma genitalium is a significant sexually transmitted pathogen, causing up to 25% of cases of non-gonococcal urethritis in men and is strongly associated with cervicitis and pelvic inflammatory disease in women. Currently, the usual first-line treatment is with the macrolide antibiotic, azithromycin, but an increasing incidence of treatment failure over the last five years suggests emergence of resistance. Mutations responsible for macrolide resistance have been found in the 23S rRNA gene (23S rDNA) in numerous M. genitalium populations. A second-line antibiotic, the fluoroquinolone moxifloxacin, was thought to be a reliable alternative when azithromycin failed, but recent studies have identified mutations in the genes, parC and gyrA, that may confer fluoroquinolone resistance.The aim of this study was to determine the prevalence of antibiotic resistance in M. genitalium in Sydney, Australia, by detection of relevant mutations in 23S rDNA, parC and gyrA. M. genitalium-positive DNA extracts of specimens, collected from patients attending sexual health clinics in Sydney, were tested by PCR amplification and DNA sequence alignment. The 186 specimens tested included 143 initial patient specimens, and 43 second, or subsequent, specimens from 24 patients. We identified known macrolide resistance-associated mutations in 23S rDNA of 43%, and mutations potentially associated with fluoroquinolone resistance in parC or gyrA sequences of 15%, of initial patient samples. These findings support anecdotal clinical reports of azithromycin and moxifloxacin treatment failures in Sydney. Our results indicated that further surveillance is needed and testing and treatment protocols for M. genitalium infections may need to be reviewed.
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