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Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Guided antibiotic therapy for Mycoplasma genitalium infections: Analysis of muta...
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Vol. 37. Issue 6.
Pages 394-397 (June - July 2019)
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Vol. 37. Issue 6.
Pages 394-397 (June - July 2019)
Brief report
DOI: 10.1016/j.eimce.2019.03.005
Guided antibiotic therapy for Mycoplasma genitalium infections: Analysis of mutations associated with resistance to macrolides and fluoroquinolones
Tratamiento antibiótico dirigido en infecciones por Mycoplasma genitalium: análisis de mutaciones asociadas con resistencia a macrólidos y fluoroquinolonas
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Luis Piñeiroa,
Corresponding author
, Pedro Idigorasa, Idoia de la Cabaa, Maddi López-Olaizolaa, Gustavo Cillaa,b
a Servicio de Microbiología, Hospital Universitario Donostia-Instituto de Investigación Sanitaria BioDonostia, San Sebastián, Spain
b Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), San Sebastián, Spain
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Tables (2)
Table 1. Position and frequency of mutations detected in the 23S rRNA, parC and gyrA genes of Mycoplasma genitalium.
Table 2. Differences observed in macrolide resistance rates based on prior treatment with azithromycin, the dose used or the service of origin of the patients.
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Abstract
Introduction

The objective of this study was to analyse the susceptibility of Mycoplasma genitalium to macrolides and fluoroquinolones using molecular techniques.

Methods

Susceptibility to macrolides was tested (Gipuzkoa, 2014–2017) by a rapid probe-based real-time polymerase chain reaction assay (23S rRNA gene) and to fluoroquinolones by sequencing the parC and gyrA genes.

Results

Mutations associated with macrolide resistance were detected in 43/263 (16.3%) cases and potential fluoroquinolone resistance in 21/267 (7.9%). Macrolide resistance was more frequent in patients previously treated with azithromycin (76.5% vs 7.4%, p<0.001) as well as in those treated with a single 1g dose (31.3%) vs the extended regimen (7%, p<0.001). There were 5/245 (2%) cases with mutations probably associated with resistance to both antibiotics.

Conclusions

The technique used for testing M. genitalium susceptibility to azithromycin allowed the rapid implementation of resistance-guided antibiotic therapy. Moxifloxacin could be a good option in cases of macrolide resistance.

Keywords:
Mycoplasma genitalium
Antibiotic susceptibility
Guided therapy
Resumen
Introducción

El objetivo de este trabajo fue analizar la susceptibilidad de Mycoplasma genitalium a macrólidos y fluoroquinolonas mediante técnicas moleculares.

Métodos

La susceptibilidad a macrólidos se analizó (Gipuzkoa, 2014-2017) mediante PCR en tiempo real con sondas (gen 23S ARNr) y a fluoroquinolonas mediante secuenciación tras PCR convencionales (genes parC/gyrA).

Resultados

Se detectaron mutaciones asociadas con resistencia a macrólidos en 43/263 (16,3%) casos y con posible resistencia a fluoroquinolonas en 21/267 (7,9%). La resistencia a macrólidos fue más frecuente tras tratamiento previo con azitromicina (76,5 vs. 7,4%; p<0,001) y con la pauta única de 1g (31,3 vs. 7% pauta ampliada, p<0,001). Se detectaron 5/245 (2%) casos con mutaciones de posible resistencia para ambos antibióticos.

Conclusiones

La técnica empleada para el estudio de la susceptibilidad de Mycoplasma genitalium a la azitromicina permitió una respuesta rápida con un tratamiento antibiótico dirigido. Moxifloxacino puede ser una buena alternativa en casos con resistencia a macrólidos.

Palabras clave:
Mycoplasma genitalium
Susceptibilidad antibiótica
Tratamiento dirigido

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