Failure of moxifloxacin treatment in Mycoplasma genitalium infections due to macrolide and fluoroquinolone resistance

Author:

Couldwell Deborah L12,Tagg Kaitlin A34,Jeoffreys Neisha J4,Gilbert Gwendolyn L24

Affiliation:

1. Western Sydney Sexual Health Centre, Westmead Hospital, Parramatta, NSW, Australia

2. Sydney Emerging Infections and Biosecurity Institute, University of Sydney, Sydney, NSW, Australia

3. Department of Biological Sciences, Macquarie University, North Ryde, NSW, Australia

4. Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia

Abstract

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.

Publisher

SAGE Publications

Subject

Infectious Diseases,Pharmacology (medical),Public Health, Environmental and Occupational Health,Dermatology

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