title: Multidrug-resistant Mycoplasma genitalium infections in Europe.
abstract: In Japan and Australia, multidrug-resistant Mycoplasma genitalium infections are reported with increasing frequency. Although macrolide-resistant M. genitalium strains are common in Europe and North America, fluoroquinolone-resistant strains are still exceptional. However, an increase of multidrug-resistant M. genitalium in Europe and America is to be expected. The aim of this paper is to increase awareness on the rising number of multidrug-resistant M. genitalium strains. Here, one of the first cases of infection with a genetically proven multidrug-resistant M. genitalium strain in Europe is described. The patient was a native Dutch 47-year-old male patient with urethritis. Mycoplasma genitalium was detected, but treatment failed with azithromycin, doxycycline and moxifloxacin. A urogenital sample was used to determine the sequence of the 23S rRNA, gyrA, gyrB and parC genes. The sample contained an A2059G single nucleotide polymorphism (SNP) in the 23S rRNA gene and an SNP in the parC gene, resulting in an amino acid change of Ser83 → Ile, explaining both azithromycin and moxifloxacin treatment failure. The SNPs associated with resistance were probably generated de novo, as a link with high-prevalence areas was not established. It is, thus, predictable that there is going to be an increase of multidrug-resistant M. genitalium strains in Europe. As treatment options for multidrug-resistant M. genitalium are limited, the treatment of M. genitalium infections needs to be carefully considered in order to limit the rapid increase of resistance to macrolides and fluoroquinolones.
authors.affiliation: Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: J F
authors.initials: JF
authors.lastname: Braam
authors.affiliation: PAMM Laboratory of Medical Microbiology, Veldhoven, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van Dommelen
authors.affiliation: Department of Dermatology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: C J M
authors.initials: CJM
authors.lastname: Henquet
authors.affiliation: PAMM Laboratory of Medical Microbiology, Veldhoven, The Netherlands.
authors.forename: J H B
authors.initials: JHB
authors.lastname: van de Bovenkamp
authors.affiliation: Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. h.kusters@umcutrecht.nl.
authors.forename: J G
authors.initials: JG
authors.lastname: Kusters
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D005060:Europe / Q000453:epidemiology; D005798:Genes, Bacterial; D006801:Humans; D008297:Male; D008875:Middle Aged; D009175:Mycoplasma Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000635:transmission; D045704:Mycoplasma genitalium / Q000187:drug effects* / Q000235:genetics; D020641:Polymorphism, Single Nucleotide; D011159:Population Surveillance
chemical_list: D000900:Anti-Bacterial Agents
keywords: Azithromycin; Chlamydia Trachomatis; Moxifloxacin; Pelvic Inflammatory Disease; Sexually Transmitted Infection