Frequency and correlates of Mycoplasma genitalium antimicrobial resistance mutations and their association with treatment outcomes: findings from a national sentinel surveillance pilot in England.

Fifer, Helen, Merrick, Rachel, Pitt, Rachel, Yung, Mandy, Allen, Hester, Day, Michaela, Sinka, Katy, Woodford, Neil, Mohammed, Hamish, Brown, Colin S, Hughes, Gwenda, Cole, Michelle, Nori, Achyuta, Evans, Amy, Richardson, Ania, Sullivan, Ann, Macrae, Bruce, Graham, Clive, Padgett, Debra, Page, Emma, Jungmann, Eva, Phattey, Jara, Glascodine, Joanna, Ross, Jonathan D C, Garvey, Lucy, Phillips, Matthew, Clarke, Michael, Rayment, Michael, Rebec, Monica, Fearnley, Nicola, Wickramasinghe, Nimal, Horner, Paddy, Cliff, Penelope, Muir, Peter, Browne, Rita, Brum, Roberta and Tittle, Victoria (2021) Frequency and correlates of Mycoplasma genitalium antimicrobial resistance mutations and their association with treatment outcomes: findings from a national sentinel surveillance pilot in England. Sexually transmitted diseases. ISSN 1537-4521.

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Official URL: 10.1097/OLQ.0000000000001493

Abstract

BACKGROUND

Mycoplasma genitalium infection is a public health concern due to extensive antimicrobial resistance (AMR). Using data from a pilot of M. genitalium AMR surveillance, we determined the prevalence and risk factors for resistance among specimens from sexual health clinic attendees and assessed treatment outcomes.

METHODS

Seventeen sexual health clinics in England sent consecutive M genitalium-positive specimens to the national reference laboratory from January to March 2019. Regions of the 23S rRNA, parC and gyrA genes associated with macrolide and fluoroquinolone resistance, respectively, were amplified and sequenced where appropriate. Fisher's exact tests, univariate and multivariable logistic regression models were used to determine associations between demographic, clinical and behavioural factors and resistance-associated mutations.

RESULTS

Over two-thirds (173/249, 69%) of M. genitalium specimens had mutations associated with macrolide resistance, while predicted fluoroquinolone (21/251, 8%) and dual-drug (12/237, 5%) resistance were less prevalent. No specimens had both gyrA and parC resistance associated mutations. Macrolide resistance was more common in specimens from men who have sex with men (MSM) compared to heterosexual men (aOR: 2.64; 95% CI: 1.09-6.38; p = 0.03). There was an association between both macrolide and fluoroquinolone resistance and having a previous STI (p = 0.06).Only 19% of individuals returned for a test-of-cure. Of those infected with a macrolide-resistant genotype who were given azithromycin, 57/78 (73%) were known or assumed to be clinically cured; however, 43/57 (75%) of these also received doxycycline. Of the 21 with a macrolide-resistant genotype who failed treatment, 18/21 (86%) also received doxycycline.

CONCLUSIONS

While macrolide resistance was widespread, particularly among specimens from MSM and those with a previous STI diagnosis in the past year, resistance-associated mutations in M. genitalium did not appear to be unequivocally predictive of treatment failure.

Item Type: Article
Subjects: WC Communicabable diseases
Divisions: Clinical Support > Infection Control
Related URLs:
Depositing User: Miss Emily Johnson
Date Deposited: 11 Jun 2021 14:19
Last Modified: 11 Jun 2021 14:19
URI: http://www.repository.uhblibrary.co.uk/id/eprint/4421

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