Initial failure of pristinamycin treatment in a case of multidrug-resistant Mycoplasma genitalium urethritis eventually treated by sequential therapy

ABSTRACT The pleuromutilin antibiotic lefamulin demonstrated in vitro activity against the most relevant bacterial pathogens causing sexually transmitted infections (STI), including Chlamydia trachomatis (MIC 50/90 , 0.02/0.04 mg/liter; n = 15), susceptible and multidrug-resistant Mycoplasma genitalium (MIC range, 0.002 to 0.063 mg/liter; n = 6), and susceptible and resistant Neisseria gonorrhoeae (MIC 50/90 , 0.12/0.5 mg/liter; n = 25). The results suggest that lefamulin could be a promising first-line antibiotic for the treatment of STI, particularly in populations with high rates of resistance to standard-of-care antibiotics.

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Multidrug-resistant Mycoplasma genitalium infections in Europe

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-017-2969-9 ◽

2017 ◽

Vol 36 (9) ◽

pp. 1565-1567 ◽

Cited By ~ 16

Author(s):

J. F. Braam ◽

L. van Dommelen ◽

C. J. M. Henquet ◽

J. H. B. van de Bovenkamp ◽

J. G. Kusters

Keyword(s):

Mycoplasma Genitalium ◽

Multidrug Resistant

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The parC mutation G248T (S83I), and concurrent gyrA mutations, are associated with moxifloxacin and sitafloxacin treatment failure for Mycoplasma genitalium

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz550 ◽

2019 ◽

Cited By ~ 1

Author(s):

Gerald L Murray ◽

Kaveesha Bodiyabadu ◽

Jennifer Danielewski ◽

Suzanne M Garland ◽

Dorothy A Machalek ◽

...

Keyword(s):

Treatment Failure ◽

Mycoplasma Genitalium ◽

Sequential Therapy ◽

Additive Effect ◽

Quinolone Resistance ◽

Optimal Selection ◽

Gyra Mutation ◽

Selection Of

Abstract Background The basis of fluoroquinolone treatment failure for Mycoplasma genitalium is poorly understood. Methods To identify mutations associated with failure we sequenced key regions of the M. genitalium parC and gyrA genes for patients undergoing sequential therapy with doxycycline-moxifloxacin (201 patients, including 21 failures) or doxycycline-sitafloxacin (126 patients, including 13 failures). Results The parC G248T/S83I mutation was more common among patients who failed sequential doxycycline-moxifloxacin (present in 76.2% of failures vs 7.8% cures, p<0.001) and doxycycline-sitafloxacin (50% failures vs 16.8% cures, p = 0.014). Doxycycline-sitafloxacin was more efficacious than doxycycline-moxifloxacin against infections carrying the ParC S83I mutation. Infections with a ParC S83I were more likely to fail treatment with a concurrent gyrA mutation (M95I or D99N) (for doxycycline- moxifloxacin group p = 0.067, for doxycycline-sitafloxacin group p = 0.0093), suggesting an additive effect. Conclusions This study indicates that parC G248T/S83I mutations contribute to failure of moxifloxacin and sitafloxacin, and will inform the development of quinolone resistance assays needed to ensure optimal selection of antimicrobials for M. genitalium.

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High Prevalence of Multidrug-Resistant Mycoplasma genitalium in Human Immunodeficiency Virus-Infected Men Who Have Sex With Men in Alabama

Clinical Infectious Diseases ◽

10.1093/cid/cix853 ◽

2017 ◽

Vol 66 (5) ◽

pp. 796-798 ◽

Cited By ~ 31

Author(s):

Jodie Dionne-Odom ◽

William M Geisler ◽

Kristal J Aaron ◽

Ken B Waites ◽

Andrew O Westfall ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Mycoplasma Genitalium ◽

Multidrug Resistant ◽

Immunodeficiency Virus ◽

High Prevalence ◽

Sex With Men

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Two cases of multidrug-resistant genitourinary Mycoplasma genitalium infection successfully eradicated with minocycline

International Journal of STD & AIDS ◽

10.1177/0956462418816757 ◽

2019 ◽

Vol 30 (5) ◽

pp. 512-514 ◽

Cited By ~ 6

Author(s):

Allison M Glaser ◽

William M Geisler ◽

Amy E Ratliff ◽

Li Xiao ◽

Ken B Waites ◽

...

Keyword(s):

Public Health ◽

Antimicrobial Resistance ◽

Mycoplasma Genitalium ◽

Multidrug Resistant ◽

Health Concern ◽

Public Health Concern ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Nongonococcal Urethritis ◽

Extended Course

Mycoplasma genitalium (MG) infection is a sexually transmitted infection that causes up to 25% of nongonococcal urethritis (NGU). MG strains carrying genetic markers of antimicrobial resistance that may affect treatment outcomes are increasingly recognized as a public health concern. We present two cases of persistent MG NGU with strains carrying both macrolide and quinolone resistance-associated mutations that were eradicated successfully by an extended course of minocycline.

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