Abstract
BackgroundThe rapid spread of azithromycin resistance in sexually transmitted Mycoplasma genitalium infections is a growing concern. It is not yet clear to what degree macrolide resistance in M. genitalium results from the emergence of de novo mutations or the transmission of resistant strains.MethodsWe developed a compartmental transmission model to investigate the contribution of de novo macrolide resistance mutations to the spread of antimicrobial-resistant M. genitalium. We fitted the model to resistance data from France, Denmark and Sweden, estimated the time point of azithromycin introduction and the rates at which infected individuals receive treatment, and projected the future spread of resistance.ResultsThe high probability of de novo resistance in M. genitalium accelerates the early spread of antimicrobial resistance. The relative contribution of de novo resistance subsequently decreases, and the spread of resistant infections in France, Denmark and Sweden is now mainly driven by transmitted resistance. If treatment with single-dose azithromycin continues at current rates, macrolide-resistant M. genitalium infections will reach 25% (95% confidence interval, CI [9–30]%) in France, 84% (95% CI [36–98]%) in Denmark and 62% (95% CI [48–76]%) in Sweden by 2025.ConclusionsBlind treatment of urethritis with single-dose azithromycin continues to select for the spread of macrolide resistant M. genitalium. Clinical management strategies for M. genitalium should limit the unnecessary use of macrolides.
Highlights
Macrolide-resistant Mycoplasma genitalium poses a considerable problem for clinical practice and public health, with more than 40% of detected infections being resistant in several countries (Gesink et al, 2012; Pond et al, 2014; Salado-Rasmussen & Jensen, 2014; Murray et al, 2017)
We developed a mathematical model of M. genitalium transmission and fitted it to epidemiological data about time trends in macrolide resistance
We further showed that de novo resistance emergence accelerated the early spread of macrolide-resistant M. genitalium, whereas the spread of resistant infections is mainly driven by transmitted resistance
Summary
Macrolide-resistant Mycoplasma genitalium poses a considerable problem for clinical practice and public health, with more than 40% of detected infections being resistant in several countries (Gesink et al, 2012; Pond et al, 2014; Salado-Rasmussen & Jensen, 2014; Murray et al, 2017). Understanding the spread of de novo and transmitted macrolide-resistance in Mycoplasma genitalium. The rapid spread of azithromycin resistance in sexually transmitted Mycoplasma genitalium infections is a growing concern. It is not yet clear to what degree macrolide resistance in M. genitalium results from the emergence of de novo mutations or the transmission of resistant strains. We developed a compartmental transmission model to investigate the contribution of de novo macrolide resistance mutations to the spread of antimicrobialresistant M. genitalium. If treatment with single-dose azithromycin continues at current rates, macrolide-resistant M. genitalium infections will reach 25% (95% confidence interval, CI [9–30]%) in France, 84% (95% CI [36– 98]%) in Denmark and 62% (95% CI [48–76]%) in Sweden by 2025. Blind treatment of urethritis with single-dose azithromycin continues to select for the spread of macrolide resistant M. genitalium. Clinical management strategies for M. genitalium should limit the unnecessary use of macrolides
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