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Surveillance Open Access
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Abstract

Background

Antimicrobial resistance (AMR) of (MG) is a growing concern worldwide and surveillance is needed. In Belgium, samples are sent to the National Reference Centre of Sexually Transmitted Infections (NRC-STI) on a voluntary basis and representative or robust national AMR data are lacking.

Aim

We aimed to estimate the occurrence of resistant MG in Belgium.

Methods

Between July and November 2022, frozen remnants of MG-positive samples from 21 Belgian laboratories were analysed at the NRC-STI. Macrolide and fluoroquinolone resistance-associated mutations (RAMs) were assessed using Sanger sequencing of the 23SrRNA and gene. Differences in resistance patterns were correlated with surveillance methodology, socio-demographic and behavioural variables via Fisher’s exact test and logistic regression analysis.

Results

Of the 244 MG-positive samples received, 232 could be sequenced for macrolide and fluoroquinolone RAMs. Over half of the sequenced samples (55.2%) were resistant to macrolides. All sequenced samples from men who have sex with men (MSM) (24/24) were macrolide-resistant. Fluoroquinolone RAMs were found in 25.9% of the samples and occurrence did not differ between socio-demographic and sexual behaviour characteristics.

Conclusion

Although limited in sample size, our data suggest no additional benefit of testing MG retrieved from MSM for macrolide resistance in Belgium, when making treatment decisions. The lower occurrence of macrolide resistance in other population groups, combined with emergence of fluoroquinolone RAMs support macrolide-resistance testing in these groups. Continued surveillance of resistance in MG in different population groups will be crucial to confirm our findings and to guide national testing and treatment strategies.

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/content/10.2807/1560-7917.ES.2024.29.7.2300318
2024-02-15
2024-11-22
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.7.2300318
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References

  1. Baumann L, Cina M, Egli-Gany D, Goutaki M, Halbeisen FS, Lohrer G-RR, et al. Prevalence of Mycoplasma genitalium in different population groups: systematic review andmeta-analysis. Sex Transm Infect. 2018;94(4):255-62.  https://doi.org/10.1136/sextrans-2017-053384  PMID: 29440466 
  2. Reyniers T, Nöstlinger C, Laga M, De Baetselier I, Crucitti T, Wouters K, et al. Choosing between daily and event-driven pre-exposure prophylaxis: results of a Belgian PrEP demonstration project. J Acquir Immune Defic Syndr. 2018;79(2):186-94.  https://doi.org/10.1097/QAI.0000000000001791  PMID: 29975211 
  3. Coorevits L, Traen A, Bingé L, Descheemaeker P, Boelens J, Reynders M, et al. Macrolide resistance in Mycoplasma genitalium from female sex workers in Belgium. J Glob Antimicrob Resist. 2018;12:149-52.  https://doi.org/10.1016/j.jgar.2017.09.018  PMID: 28988903 
  4. Hetem DJ, Kuizenga Wessel S, Bruisten SM, Braam JF, van Rooijen MS, Vergunst CE, et al. High prevalence and resistance rates of Mycoplasma genitalium among patients visiting two sexually transmitted infection clinics in the Netherlands. Int J STD AIDS. 2021;32(9):837-44.  https://doi.org/10.1177/0956462421999287  PMID: 33861668 
  5. Manhart LE, Geisler WM, Bradshaw CS, Jensen JS, Martin DH. Weighing potential benefits and harms of Mycoplasma genitalium testing and treatment approaches. Emerg Infect Dis. 2022;28(8):e220094.  https://doi.org/10.3201/eid2808.220094  PMID: 35876565 
  6. Wood GE, Bradshaw CS, Manhart LE. Update in epidemiology and management of Mycoplasma genitalium infections. Infect Dis Clin North Am. 2023;37(2):311-33.  https://doi.org/10.1016/j.idc.2023.02.009  PMID: 37105645 
  7. Jensen JS, Cusini M, Gomberg M, Moi H, Wilson J, Unemo M. 2021 European guideline on the management of Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2022;36(5):641-50.  https://doi.org/10.1111/jdv.17972  PMID: 35182080 
  8. Horner PJ, Blee K, Falk L, van der Meijden W, Moi H. 2016 European guideline on the management of non-gonococcal urethritis. Int J STD AIDS. 2016;27(11):928-37.  https://doi.org/10.1177/0956462416648585  PMID: 27147267 
  9. Read TRH, Fairley CK, Murray GL, Jensen JS, Danielewski J, Worthington K, et al. Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation. Clin Infect Dis. 2019;68(4):554-60.  https://doi.org/10.1093/cid/ciy477  PMID: 29873691 
  10. De Baetselier I, Kenyon C, Vanden Berghe W, Smet H, Wouters K, Van den Bossche D, et al. An alarming high prevalence of resistance-associated mutations to macrolides and fluoroquinolones in Mycoplasma genitalium in Belgium: results from samples collected between 2015 and 2018. Sex Transm Infect. 2021;97(4):297-303.  https://doi.org/10.1136/sextrans-2020-054511  PMID: 32769204 
  11. Pereyre S, Laurier-Nadalié C, Le Roy C, Guiraud J, Dolzy A, Hénin N, et al. Prevalence of macrolide and fluoroquinolone resistance-associated mutations in Mycoplasma genitalium in metropolitan and overseas France. Sex Transm Infect. 2023;99(4):254-60. PMID: 36413349 
  12. Fifer H, Merrick R, Pitt R, Yung M, Allen H, Day M, et al. Frequency and correlates of Mycoplasma genitalium antimicrobial resistance mutations and their association with treatment outcomes: findings from a national sentinel surveillance pilot in England. Sex Transm Dis. 2021;48(12):951-4.  https://doi.org/10.1097/OLQ.0000000000001493  PMID: 34108410 
  13. Public Health England (PHE). Mycoplasma genitalium Antimicrobial Resistance Surveillance (MARS). Second pilot report. London: PHE; 2021. Available from: https://assets.publishing.service.gov.uk/media/611697b2e90e07054eb85da2/MARS_pilot_report_2021.pdf
  14. Jensen JS. Protocol for the Detection of Mycoplasma genitalium by PCR from Clinical Specimens and Subsequent Detection of Macrolide Resistance-Mediating Mutations in Region V of the 23S rRNA Gene. In: MacKenzie C, Henrich B. (editors). Diagnosis of Sexually Transmitted Diseases. Methods in Molecular Biology, vol 903. Totowa: Humana Press; 2012. P. 129-39.
  15. Shimada Y, Deguchi T, Nakane K, Masue T, Yasuda M, Yokoi S, et al. Emergence of clinical strains of Mycoplasma genitalium harbouring alterations in ParC associated with fluoroquinolone resistance. Int J Antimicrob Agents. 2010;36(3):255-8.  https://doi.org/10.1016/j.ijantimicag.2010.05.011  PMID: 20580532 
  16. Sweeney EL, Whiley DM, Murray GL, Bradshaw CS. Mycoplasma genitalium: enhanced management using expanded resistance-guided treatment strategies. Sex Health. 2022;19(4):248-54.  https://doi.org/10.1071/SH22012  PMID: 35617973 
  17. Belgian Health care Knowledge Centre (KCE). Aanpak van SOA’s door de eerste lijn n.d. [Testing STIs in a sexual health consultation]. Brussels: KCE; 2019. Dutch. Available from: https://www.soa.kce.be/en/treatment.html
  18. De Baetselier I, Cuylaerts V, Smet H, Abdellati S, De Caluwe Y, Taïbi A, et al. Neisseria gonorrhoeae antimicrobial resistance surveillance report of Belgium – 2022. Antwerp: Institute of Tropical Medicine; 2022. Available from: https://www.sciensano.be/sites/default/files/amr_ng_report_2022_v1.0_20230412.pdf
  19. Piñeiro L, Idigoras P, Arrastia M, Manzanal A, Ansa I, Cilla G. Increases in the macrolide resistance of Mycoplasma genitalium and the emergence of the A2058T mutation in the 23S rRNA gene: clonal spread? Antibiotics (Basel). 2022;11(11):1492.  https://doi.org/10.3390/antibiotics11111492  PMID: 36358147 
  20. Braam JF, Slotboom B, Van Marm S, Severs TT, Van Maarseveen NM, Van Zwet T, et al. High prevalence of the A2058T macrolide resistance-associated mutation in Mycoplasma genitalium strains from the Netherlands. J Antimicrob Chemother. 2017;72(5):1529-30.  https://doi.org/10.1093/jac/dkw584  PMID: 28158595 
  21. Angela A, Raffaele DP, Federica R, Adriana M, Luigi S, Luigi R. Multi-year prevalence and macrolide resistance of Mycoplasma genitalium in clinical samples from a southern Italian hospital. Eur J Clin Microbiol Infect Dis. 2021;40(4):893-5.  https://doi.org/10.1007/s10096-020-04068-3  PMID: 33078220 
  22. Perry MD, Jones S, Bertram A, de Salazar A, Barrientos-Durán A, Schiettekatte G, et al. The prevalence of Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) at testing centers in Belgium, Germany, Spain, and the UK using the cobas TV/MG molecular assay. Eur J Clin Microbiol Infect Dis. 2023;42(1):43-52.  https://doi.org/10.1007/s10096-022-04521-5  PMID: 36369413 
  23. Kenyon C, Vanbaelen T, Van Dijck C. Recent insights suggest the need for the STI field to embrace a more eco-social conceptual framework: a viewpoint. Int J STD AIDS. 2022;33(4):404-15.  https://doi.org/10.1177/09564624211064133  PMID: 34982008 
  24. Vermeulen H, Coenen S, Hens N, Bruyndonckx R. Impact of changing reimbursement criteria on the use of fluoroquinolones in Belgium. J Antimicrob Chemother. 2021;76(10):2725-32.  https://doi.org/10.1093/jac/dkab255  PMID: 34374778 
  25. Ly N, Flach C, Lysen TS, Markov E, van Ballegooijen H, Rijnbeek P, et al. Study of impact of EU label changes for fluoroquinolone containing medicinal products for systemic and inhalation use - post-referral prescribing trends. Drug Saf. 2023;46(4):405-16.  https://doi.org/10.1007/s40264-023-01286-4  PMID: 36976448 
  26. Murray GL, Bodiyabadu K, Vodstrcil LA, Machalek DA, Danielewski J, Plummer EL, et al. parC variants in Mycoplasma genitalium: trends over time and association with moxifloxacin failure. Antimicrob Agents Chemother. 2022;66(5):e0027822.  https://doi.org/10.1128/aac.00278-22  PMID: 35475636 
  27. Raccagni AR, Bruzzesi E, Spagnuolo V, Canetti D, Castagna A, Nozza S. 'Multidrug-resistant Mycoplasma genitalium urethritis: successful eradication with sequential therapy. Sex Transm Infect. 2023;99(1):77.  https://doi.org/10.1136/sextrans-2022-055678  PMID: 36601744 
  28. Goodfellow JJ, Hughes S, Smith J, Jones R, Moore LSP, Rayment M. Novel use of oral chloramphenicol for treatment-resistant Mycoplasma genitalium. Sex Transm Infect. 2023;99(3):208-10. PMID: 36717253 
  29. Murray GL, Plummer EL, Bodiyabadu K, Vodstrcil LA, Huaman JL, Danielewski JA, et al. gyrA mutations in Mycoplasma genitalium and their contribution to moxifloxacin failure: time for the next generation of resistance-guided therapy. Clin Infect Dis. 2023;76(12):2187-95.  https://doi.org/10.1093/cid/ciad057  PMID: 36722416 
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