P601 Macrolide and fluoroquinolone resistance-associated mutations in mycoplasma genitalium: a systematic review and meta-analysis. (14th July 2019)

• Record Type: Journal Article
• Authors: Machalek, Dorothy; Tao, Yusha; Shilling, Hannah; Jensen, Jorgen; Unemo, Magnus; Murray, Gerald; Chow, Eric; Low, Nicola; Garland, Suzanne; Fairley, Christopher; Vodstrcil, Lenka; Hocking, Jane; Zhang, Lei; Bradshaw, Catriona
• Is Part Of: Sexually transmitted infections. Volume 95(2019)Supplement 1
• Page Start: A266
• Page End: A266
• Publication Date: 2019-07-14
• Subjects: Mycoplasma genitalium -- antimicrobial resistance -- meta-analysis; Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2019-sti.669
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Background: Treatment for Mycoplasma genitalium is becoming increasingly complicated by antimicrobial resistance. We summarised published global data on the prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium and examined trends over time. Methods: We searched PubMed, EMBASE and Medline until December 31, 2017. We included studies that reported the percentage of key mutations associated with macrolide resistance (23S rRNA gene: A2071C/G/T; A2072C/G/T) and/or fluoroquinolone failure (p arC gene: S83R/I; D87N/Y) among M. genitalium positive specimens. Data were extracted by geographic region, collection year, sex, and risk group (men who have sex with men [MSM] or heterosexual). Summary estimates (95% confidence intervals [CI]) were calculated using random-effects meta-analyses. Subgroup and meta-regression analyses were conducted to assess heterogeneity. Results: 47 studies met the inclusion criteria reporting resistance-associated mutations for macrolides (n=45) and fluoroquinolones (n=18). Global prevalence of macrolide resistance mutations increased from 4.9% [95% CI 0.0–15.7%] before 2009, to 46.3% [30.7–62.2%] in 2016–17 (p-trend=0.001). This increase was greatest in the Western Pacific region (Australia in particular) where prevalence increased from 12.6% [2.6–26.9%] to 69.2% [60.7–77.1%] (p-trend<0.001). Prevalence of macrolide resistance-associated mutations was also higher among MSM (72.3% [58.6–84.5%]) than heterosexual men (37.3% [25.8–49.6%]) (p<0.001). Global prevalence of fluoroquinolone resistance mutations was 6.3% [4.2–8.9%] with no changes over time or by risk group, but regional variations were present with highest prevalence in the Western Pacific region (14.9% [9.7–20.9%]) and North America (11.2% [2.9–23.3%]), and lowest in Europe (2.8% [1.7–4.1%]). Dual class resistance mutation prevalence was 2.5% [1.1–4.2%] with no change over time or by risk group. Regional variations were similar to those for fluoroquinolone resistance mutations. Conclusion: Resistance to recommended first and second line treatments for M. genitalium is a growing public health problem. Global surveillance and antimicrobial resistance-guided therapies are needed to inform more effective regional strategies for the control and treatment of M. genitalium . Disclosure: No significant relationships.