Abstract
Macrolide or fluoroquinolone-resistant Mycoplasma genitalium is spreading worldwide. We aimed to determine the influence of single nucleotide polymorphisms (SNPs) in the quinolone resistance determining regions (QRDR) of parC and gyrA in cultured M. genitalium strains. In addition, we examined the prevalence of macrolide- and fluoroquinolone resistance mediating mutations in specimens collected from Japanese male patients with urethritis in two time-periods between 2005–2009 and 2010–2017, respectively, by sequencing the QRDR of parC and gyrA and domain V of the 23S rRNA gene. The minimum inhibitory concentrations (MIC) of moxifloxacin, sitafloxacin, ciprofloxacin, levofloxacin, doxycycline, minocycline, azithromycin and clarithromycin were determined in 23 M. genitalium strains. Three cultured strains had elevated MICs for moxifloxacin at 16, 4 and 2 mg/L and had SNPs with the amino-acid change Ser83→Ile in ParC (p<0.001) and 3 kinds of SNPs with amino-acid changes Asp99→Asn, Gly93→Cys and Met95→Ile in GyrA, respectively. Among a total of 148 M. genitalium positive urine specimens, the prevalence of A2058G and A2059G SNPs in the 23S rRNA gene and any SNPs in ParC increased from 4.8% and 22.6% in 2005–2009 to 42.2% and 53.1% in 2010–2017, respectively. If M. genitalium is considered multi-drug resistant in clinical specimens carrying SNPs in the 23S rRNA gene and Ser83→Ile in ParC, the prevalence of multi-drug resistance is 12.5% in 2010–2017 in Japan. In conclusion, the SNP resulting in Ser83→Ile in ParC is closely related to moxifloxacin resistance even though other factors may also affect treatment outcomes by moxifloxacin. The prevalence of circulating multi-drug resistant M. genitalium strains with macrolide- and fluoroquinolone-resistance is dramatically increasing in Japan.
Highlights
Mycoplasma genitalium is a pathogen causing male urethritis, female cervicitis and other sexually transmitted infection syndromes [1,2,3]
Especially using azithromycin (AZM) were thought to be superior to tetracycline regimens for M. genitalium infections [5,6,7], and the AZM regimens have been widely used as the first line treatment for non-gonococcal urethritis in many countries
Macrolides cannot be used as the first line treatment in many settings without testing for macrolide resistance mediating mutations as the prevalence of resistance is close to 50%
Summary
Mycoplasma genitalium is a pathogen causing male urethritis, female cervicitis and other sexually transmitted infection syndromes [1,2,3]. Treatment failure by AZM regimens in M. genitalium urethritis in men has been reported [8], and AZM resistant M. genitalium strains were subsequently isolated [9]. This resistance was closely related to mutations in positions A2058 or A2059 of the 23S rRNA gene (Escherichia coli numbering) mainly to G (C or T is relatively rare). These two positions are in the active site for macrolide binding, and similar mutations have been observed among macrolide resistant Mycoplasma pneumoniae [10]. The prevalence of macrolide resistance in M. genitalium has reached 50% in Australia [11], Denmark [12], and Japan [13, 14], and macrolide resistant M. genitalium has become a problem worldwide
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