Abstract
Background and objectiveResistance in the sexually transmitted bacterium Mycoplasma genitalium to all recommended therapeutic antimicrobials have rapidly emerged. However, to date, internationally reported resistance surveillance data for M. genitalium strains circulating in Eastern Europe are entirely lacking. The aim of this study was to estimate the prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium in four cities in Russia and one in Estonia, 2013–2016.Materials and methodsConsecutive urogenital samples found positive for M. genitalium during diagnostic testing were retrospectively analyzed for resistance-associated mutations in the 23S rRNA and parC genes using pyrosequencing and conventional Sanger sequencing, respectively.ResultsIn total, 867 M. genitalium positive samples from 2013–2016 were analyzed. Macrolide resistance-associated mutations were detected in 4.6% of the samples from Russia (0.7–6.8% in different cities) and in 10% of the samples from Estonia. The mutations A2059G and A2058G were highly predominating in both Russia and Estonia, accounting together for 90.9% of the cases positive for nucleotide substitutions in the 23S rRNA gene. The rates of possible fluoroquinolone resistance-associated mutations were 6.2% in Russia (2.5–7.6% in different cities) and 5% in Estonia. The mutations S83I and S83N were the most frequent ones in Russia (24.4% each), whereas D87N highly predominated in Estonia (83.3% of all fluoroquinolone resistance-associated mutations). Approximately 1% of the samples in both countries harbored both macrolide and possible fluoroquinolone resistance-associated mutations, with A2058G and S83I being the most frequent combination (37.5%).ConclusionsThe prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium was 4.6% and 6.2%, respectively, in Russia, and 10% and 5%, respectively, in Estonia. Despite the relatively low rates of macrolide and fluoroquinolone resistance in these countries, antimicrobial resistance surveillance and testing for resistance-associated mutations in M. genitalium positive cases would be valuable.
Highlights
Mycoplasma genitalium frequently causes urethritis in men, and urethritis and cervicitis in women [1]
Macrolide resistance-associated mutations were detected in 4.6% of the samples from Russia (0.7– 6.8% in different cities) and in 10% of the samples from Estonia
In men with symptomatic non-gonococcal urethritis (NGU), M. genitalium has been detected in 15% to 25% of cases [1]
Summary
Mycoplasma genitalium frequently causes urethritis in men, and urethritis and cervicitis in women [1]. The recommended syndromic first-line treatment for male NGU in the 2016 European guideline is doxycycline 100 mg twice daily or 200 mg once daily orally for seven days. In the 2016 European guideline on M. genitalium infections, the extended azithromycin regimen is the first-line treatment when macrolide resistance status is unknown. Patients with M. genitalium macrolide-resistant strains should be treated with moxifloxacin 400 mg once daily for 7(-10) days [4],[5]. The extended regimen of azithromycin, 500 mg day one followed by 250 mg days 2–5, is more efficacious than 1 g single dose treatment [1],[4],[5]. The extended azithromycin regimen fails to treat azithromycin-resistant M. genitalium infections [7]. The aim of this study was to estimate the prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium in four cities in Russia and one in Estonia, 2013–2016
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