Failure of moxifloxacin treatment in Mycoplasma genitalium infections due to macrolide and fluoroquinolone resistance.
Increasing azithromycin treatment failure in sexually transmitted Mycoplasma genitalium infection, is linked to macrolide resistance and second-line treatment relies on the fluoroquinolone, moxifloxacin. We recently detected fluoroquinolone and macrolide resistance-associated mutations in 15% and 43%, respectively, of 143 initial M. genitalium PCR-positive specimens. For a subset of 33 Western Sydney Sexual Health Centre patients, clinical information and results of sequence analysis of M. genitalium macrolide and fluoroquinolone target genes - the 23S rRNA gene, and parC and gyrA, respectively - were used to examine whether mutations were associated with treatment failure. Macrolide resistance-associated mutations correlated with microbiological (p = 0.013) and clinical (p = 0.024) treatment failure, and fluoroquinolone resistance-associated mutations with microbiological moxifloxacin treatment failure (p = 0.005). We describe the first reported cases of clinical and microbiological moxifloxacin treatment failure. Failure of first- and second-line antibiotic treatment of M. genitalium infection is occurring and likely to increase with current treatment strategies.
Western Sydney Sexual Health Centre, Westmead Hospital, Parramatta, NSW, Australia.
Deborah L
DL
Couldwell
Kaitlin A
KA
Tagg
Neisha J
NJ
Jeoffreys
Gwendolyn L
GL
Gilbert
D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001372:Aza Compounds / Q000627:therapeutic use*; D027081:DNA Gyrase / Q000235:genetics; D027101:DNA Topoisomerase IV / Q000235:genetics; D004269:DNA, Bacterial / Q000235:genetics; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D018942:Macrolides / Q000494:pharmacology* / Q000627:therapeutic use; D000077266:Moxifloxacin; D009154:Mutation; D009175:Mycoplasma Infections / Q000188:drug therapy* / Q000235:genetics / Q000382:microbiology; D045704:Mycoplasma genitalium / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D011804:Quinolines / Q000627:therapeutic use*; D012338:RNA, Ribosomal, 23S / Q000235:genetics; D017422:Sequence Analysis, DNA; D017211:Treatment Failure
D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D004269:DNA, Bacterial; D024841:Fluoroquinolones; D018942:Macrolides; D011804:Quinolines; D012338:RNA, Ribosomal, 23S; D027101:DNA Topoisomerase IV; D027081:DNA Gyrase; D000077266:Moxifloxacin
Australia; Mycoplasma genitalium; STI; Sexually transmitted infections; antibiotic; bacterial disease; location; non-gonococcal urethritis; resistance; treatment; treatment failure