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J Antimicrob Chemother. 2014 Sep;69(9):2376-82. doi: 10.1093/jac/dku164. Epub 2014 Jun 2.

Remarkable increase in fluoroquinolone-resistant Mycoplasma genitalium in Japan.

Author information

1
Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan.
2
iClinic, Sendai, Japan.
3
Infectious Disease Testing Department, Mitsubishi Chemical Medience Corporation, Tokyo, Japan.
4
Department of Microbiology, Graduate School of Medicine, Gifu University, Gifu, Japan.
5
Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan deguchit@gifu-u.ac.jp.

Abstract

OBJECTIVES:

We determined the prevalence of macrolide and fluoroquinolone resistance-associated mutations in Mycoplasma genitalium DNA specimens from men with non-gonococcal urethritis (NGU) and analysed their effects on antibiotic treatments of M. genitalium infections.

METHODS:

In this retrospective study, we examined antibiotic resistance-associated mutations in the 23S rRNA, gyrA and parC genes of M. genitalium and the association of the mutations with microbiological outcomes of antibiotic treatments in men with M. genitalium-positive NGU.

RESULTS:

No macrolide resistance-associated mutations in the 23S rRNA gene were observed in 27 M. genitalium DNA specimens in 2011 and in 24 in 2012. However, 5 of 17 in 2013 had 23S rRNA mutations. Three of 15 in 2011, 6 of 19 in 2012 and 8 of 17 in 2013 had fluoroquinolone resistance-associated alterations in ParC. Three in 2013 had both the antibiotic resistance-associated alterations coincidentally. In two men with M. genitalium harbouring 23S rRNA mutations, the mycoplasma persisted after treatment with a regimen of 2 g of extended-release azithromycin (AZM-SR) once daily for 1 day. All nine men with mycoplasma harbouring ParC alterations were microbiologically cured with a regimen of 100 mg of sitafloxacin twice daily for 7 days.

CONCLUSIONS:

Macrolide- or fluoroquinolone-resistant M. genitalium appears to be increasing, and the increase in fluoroquinolone-resistant mycoplasmas is especially remarkable in Japan. Mycoplasmas harbouring 23S rRNA mutations would be resistant to the AZM-SR regimen, but those harbouring ParC alterations would still be susceptible to the sitafloxacin regimen.

KEYWORDS:

23S rRNA; GyrA; ParC; azithromycin; sitafloxacin

PMID:
24894419
DOI:
10.1093/jac/dku164
[Indexed for MEDLINE]

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