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

Wujian Ke,Yuying Liao,Liuyuan Wang,Dongling Li,Heping Zheng,Xiaohui Zhang,Zhengyu Chen,Chunmei Liang,Ran Wei,Huiru Chen,Yahui Liu,Lai Sze Tso,Yinyuan Lan,Ligang Yang

doi:10.1186/s12879-020-05659-3

Abstract

BackgroundAntimicrobial 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.MethodsA 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).Results98.7% (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).ConclusionsThe 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.

Highlights

Antimicrobial resistance in M. genitalium is a growing clinical problem
We investigate the rates of Antimicrobial resistance (AMR) mutations associated with macrolide and fluoroquinolone treatment failure in M. genitalium, expanding the discussion on the use of these antibiotics in Guangzhou, China
The mutation A2072G (n = 59) was highly predominating in Guangzhou, accounting for 58.4% (59/101) of the cases found positive for nucleotide substitutions in the 23S Ribosomal ribonucleic acid (rRNA) gene

Summary

Introduction

We investigated the mutations associated with macrolide and fluoroquinolone resistance, two commonly used medical regimens for treatment in China. Antimicrobial resistance (AMR) of Mycoplasma genitalium (M. genitalium) is a growing problem with global implications for clinical guidelines and treatment [1,2,3,4,5,6]. We investigate the rates of AMR mutations associated with macrolide and fluoroquinolone treatment failure in M. genitalium, expanding the discussion on the use of these antibiotics in Guangzhou, China. Given these alarmingly high rates, it is very important to understand the background of antibiotic use in this region

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