title: Remarkable increase in fluoroquinolone-resistant Mycoplasma genitalium in Japan.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan.
authors.forename: Mina
authors.initials: M
authors.lastname: Kikuchi
authors.affiliation: iClinic, Sendai, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Ito
authors.affiliation: Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Yasuda
authors.affiliation: Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tsuchiya
authors.affiliation: Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Hatazaki
authors.affiliation: Infectious Disease Testing Department, Mitsubishi Chemical Medience Corporation, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Takanashi
authors.affiliation: Department of Microbiology, Graduate School of Medicine, Gifu University, Gifu, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ezaki
authors.affiliation: Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan deguchit@gifu-u.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Deguchi
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D027081:DNA Gyrase / Q000235:genetics; D027101:DNA Topoisomerase IV / Q000235:genetics; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007564:Japan / Q000453:epidemiology; D018942:Macrolides / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008969:Molecular Sequence Data; D009154:Mutation; D009175:Mycoplasma Infections / Q000453:epidemiology* / Q000382:microbiology; D045704:Mycoplasma genitalium / Q000187:drug effects* / Q000302:isolation & purification; D015995:Prevalence; D012338:RNA, Ribosomal, 23S / Q000235:genetics; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D024841:Fluoroquinolones; D018942:Macrolides; D012338:RNA, Ribosomal, 23S; D027101:DNA Topoisomerase IV; D027081:DNA Gyrase
keywords: 23S rRNA; GyrA; ParC; azithromycin; sitafloxacin