P081 Significant difference in macrolide and fluoroquinolone resistance in Mycoplasma genitalium in metropolitan and overseas France in 2018 and 2019

Abstract

<h3>Background</h3> Limited macrolide and fluoroquinolone resistance data are available in France for Mycoplasma genitalium. The aim of this study was to investigate the prevalence of macrolide and fluoroquinolone resistance in M. genitalium-positive men and women seeking care in metropolitan and overseas France in 2018 and 2019. <h3>Methods</h3> A one-month systematic prospective collection of M. genitalium-positive specimens was proposed between September 15th and October 15th 2018 and 2019 to metropolitan French diagnostic laboratories. A similar three-month collection between August 1st and October 31th 2018 and 2019 was proposed to overseas French microbiology diagnostic laboratories (La Réunion, Mayotte, French Guiana, French Polynesia, and New Caledonia). Macrolide resistance-associated mutations were detected using the ResistancePlus MG assay (SpeeDx) and 23S rRNA sequencing. Fluoroquinolone resistance-associated mutations in the parC gene were searched by sequencing. <h3>Results</h3> A total of 1361 specimens from 1328 patients were analyzed. In metropolitan France, macrolide resistance was 42.9% and 34.7% in 2018 and 2019, respectively, and was significantly higher in men (59.6% and 52.4%) than in women (18.7% and 15.9%, respectively, p&lt;0.001). These percentages of macrolide resistance were significantly higher than those of 6.1% and 14.7% observed in overseas France in 2018 and 2019, respectively, (p&lt;0.001), with no significant difference between men and women. Regarding fluoroquinolone resistance, rates of resistance rates were significantly higher in metropolitan France in 2018 and 2019 (16.1% and 14.9%, respectively) than in overseas France (1.3% and 2.6% in 2018 and 2019, respectively, p&lt;0.001). No difference was observed between men and women. <h3>Conclusion</h3> Macrolide and fluoroquinolone resistance rates are high in metropolitan France and contrast with significant lower rates in overseas France. In metropolitan France, macrolide resistance is up to 60% in men but three times lower in women, highlighting that gender and sexual behavior should be taken into account for the management of M. genitalium infections.