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Open Forum Infectious Diseases Aug 2023High levels of macrolide resistance and increasing fluoroquinolone resistance are making increasingly difficult to treat. Minocycline is an alternative treatment for...
BACKGROUND
High levels of macrolide resistance and increasing fluoroquinolone resistance are making increasingly difficult to treat. Minocycline is an alternative treatment for patients with macrolide-resistant infections that have failed moxifloxacin, or for those with fluoroquinolone contraindications or resistance. Published efficacy data for minocycline for are limited.
METHODS
We evaluated minocycline 100 mg twice daily for 14 days at Melbourne Sexual Health Centre (MSHC). Microbial cure was defined as a negative test of cure within 14-90 days after completing minocycline. The proportion cured and 95% confidence intervals (CIs) were calculated, and logistic regression was used to explore factors associated with treatment failure. We pooled data from the current study with a prior adjacent case series of patients with who had received minocycline 100 mg twice daily for 14 days at MSHC.
RESULTS
Minocycline cured 60 of 90 (67% [95% CI, 56%-76%]) infections. Adherence was high (96%) and side effects were mild and self-limiting. No demographic or clinical characteristics were associated with minocycline failure in regression analyses. In the pooled analyses of 123 patients, 83 (68% [95% CI, 58%-76%]) were cured following minocycline.
CONCLUSIONS
Minocycline cured 68% of macrolide-resistant infections. These data provide tighter precision around the efficacy of minocycline for macrolide-resistant and show that it is a well-tolerated regimen. With high levels of macrolide resistance, increasing fluoroquinolone resistance, and the high cost of moxifloxacin, access to nonquinolone options such as minocycline is increasingly important for the clinical management of .
PubMed: 37608915
DOI: 10.1093/ofid/ofad427 -
Pathogens (Basel, Switzerland) Mar 2023Macrolide (MLR) and fluoroquinolone (FQR) resistance in (MG) has recently become a major problem worldwide. The available data on the prevalence of MLR and FQR in MG in...
Macrolide (MLR) and fluoroquinolone (FQR) resistance in (MG) has recently become a major problem worldwide. The available data on the prevalence of MLR and FQR in MG in Russia are limited. In this study, we aimed to evaluate the prevalence and pattern of mutations in 213 MG-positive urogenital swabs from patients in Moscow between March 2021 and March 2022. MLR- and FQR-associated mutations were searched in 23S rRNA as well as in the parC and gyrA genes using Sanger sequencing. The prevalence of MLR was 55/213 (26%), with A2059G and A2058G substitutions being the two most common variants (36/55, 65%, and 19/55, 35%, respectively). FQR detection showed 17% (37/213); two major variants were D84N (20/37, 54%) and S80I (12/37, 32.4%) and three minor variants were S80N (3/37, 8.1%), D84G (1/37, 2.7%), and D84Y (1/37, 2.7%). Fifteen of the fifty-five MLR cases (27%) simultaneously harbored FQR. This study revealed the high frequency of MLR and FQR. We conclude that the improvement of patient examination algorithms and therapeutic approaches should be combined with the routine monitoring of antibiotic resistance based on the sensitivity profiles presented. Such a complex approach will be essential for restraining the development of treatment resistance in MG.
PubMed: 36986417
DOI: 10.3390/pathogens12030496 -
Sexually Transmitted Infections Aug 2019is increasingly seen as an emerging sexually transmitted pathogen, and has been likened to , but its natural history is poorly understood. The objectives of this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
is increasingly seen as an emerging sexually transmitted pathogen, and has been likened to , but its natural history is poorly understood. The objectives of this systematic review were to determine incidence, persistence, concordance between sexual partners and the risk of pelvic inflammatory disease (PID).
METHODS
We searched Medline, EMBASE, LILACS, IndMed and African Index Medicus from 1 January 1981 until 17 March 2018. Two independent researchers screened studies for inclusion and extracted data. We examined results in forest plots, assessed heterogeneity and conducted meta-analysis where appropriate. Risk of bias was assessed for all studies.
RESULTS
We screened 4634 records and included 18 studies; six (4201 women) reported on incidence, five (636 women) on persistence, 10 (1346 women and men) on concordance and three (5139 women) on PID. Incidence in women in two very highly developed countries was 1.07 per 100 person-years (95% CI 0.61 to 1.53, I 0%). Median persistence of was estimated from one to three months in four studies but 15 months in one study. In 10 studies measuring infection status in couples, 39%-50% of male or female sexual partners of infected participants also had detected. In prospective studies, PID incidence was higher in women with than those without (risk ratio 1.73, 95% CI 0.92 to 3.28, I 0%, two studies).
DISCUSSION
Incidence of in very highly developed countries is similar to that for , but concordance might be lower. Taken together with other evidence about age distribution and antimicrobial resistance in the two infections, is not the new chlamydia. Synthesised data about prevalence, incidence and persistence of infection are inconsistent. These findings can be used for mathematical modelling to investigate the dynamics of .
REGISTRATION NUMBERS
CRD42015020420, CRD42015020405.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Female; Humans; Incidence; Male; Mycoplasma Infections; Mycoplasma genitalium; Sexual Behavior; Sexual Partners; Young Adult
PubMed: 31055469
DOI: 10.1136/sextrans-2018-053823 -
Journal of Microbiology, Immunology,... May 2024Mycoplasma genitalium is an emerging etiology of sexually transmitted infections (STIs) with increasing resistance to antimicrobials. Surveillance on the epidemiology of...
BACKGROUND
Mycoplasma genitalium is an emerging etiology of sexually transmitted infections (STIs) with increasing resistance to antimicrobials. Surveillance on the epidemiology of M. genitalium infection and antimicrobial resistance is warranted.
METHODS
Between September 2021 and August 2023, people with HIV (PWH) and people without HIV (PWoH) at risk of STIs were screened for M. genitalium infection using a multiplex polymerase-chain-reaction assay of specimens collected from the rectum, urethra, oral cavity, and vagina. The prevalences of resistance-associated mutations (RAMs) of M. genitalium to fluoroquinolones, macrolides, and tetracycline were investigated.
RESULTS
During the 2-year study period, 1021 participants were enrolled, including 531 PWH and 490 PWoH. Overall, 83 (8.1%) and 34 (7.6%) participants had M. genitalium infection at baseline and during follow-up, respectively, with the rectum being the most common site of detection (61.5%). With the first course of antimicrobial treatment, 27 of 63 (42.9%) participants with M. genitalium infection were cured during follow-up, including 24 of 58 (41.4%) who received doxycycline monotherapy. The prevalence of RAMs to macrolides, fluoroquinolones, and tetracyclines at baseline were 24.3%, 22.4%, and 7.9%, respectively. Though PWH had more M. genitalium infection (10.2% vs 5.9%, p = 0.01), a higher rate of RAMs to macrolides (41.0% vs 14.7%, p < 0.01) was found in PWoH.
CONCLUSIONS
Among high-risk populations, the prevalence of M. genitalium infection was 8.1%. The overall genotypic resistance of M. genitalium to macrolides and fluoroquinolones was moderately high in Taiwan. Detection of M. genitalium infection and antimicrobial resistance is warranted to ensure resistance-guided antimicrobial treatments to be administered.
PubMed: 38777653
DOI: 10.1016/j.jmii.2024.05.004 -
International Journal of Molecular... Dec 2021The impact of sexually transmitted infections (STI) on male fertility is controversial. Aims: To investigate the prevalence of urethritis-associated STIs (chlamydia,...
The impact of sexually transmitted infections (STI) on male fertility is controversial. Aims: To investigate the prevalence of urethritis-associated STIs (chlamydia, gonorrhoeae, , trichomoniasis) among infertile males; to analyze the effect of STIs on semen parameters and blood PSA. Case-control study. Study group ( = 2000): males with fertility problems or desire for fertility check. Control group ( = 248): male partners of pregnant women. Analyses: polymerase chain reaction for STI, seminal interleukin 6 (IL-6), semen and fractionated urine, blood analyses (PSA, reproductive hormones). The prevalence of and chlamydia in the study group was 1.1% and 1.2%, respectively. The prevalence of chlamydia in the control group was 1.6%, while there were no cases. No cases with gonorrhoeae or trichomoniasis or combined infections were observed in neither group. There was a higher seminal concentration of neutrophils and IL-6 among positives compared with STI negatives. There was a trend toward a lower total count of spermatozoa and progressive motility among STI positives. No impact of STIs on PSA was found. The prevalence of STIs among infertile males is low. is associated with seminal inflammation. The impact of STIs on semen parameters deserves further investigations.
Topics: Adult; Case-Control Studies; Chlamydia Infections; Chlamydia trachomatis; Estonia; Humans; Infertility, Male; Inflammation; Interleukin-6; Male; Middle Aged; Mycoplasma Infections; Mycoplasma genitalium; Neutrophils; Prevalence; Semen; Sexually Transmitted Diseases; Spermatozoa
PubMed: 34948264
DOI: 10.3390/ijms222413467 -
Healthcare (Basel, Switzerland) Mar 2023, and are the three most commonly reported sexually transmitted bacteria. The present study aimed to investigate the presence of and in urogenital samples collected...
, and are the three most commonly reported sexually transmitted bacteria. The present study aimed to investigate the presence of and in urogenital samples collected from 18-68-year-old Turkish patients who were admitted to the hospital with various urogenital symptoms. A total of 360 patients with symptoms of STD were included in the study. Following DNA extraction by QIAamp Mini Kit, the presence of and were investigated using multiplex real-time PCR. Causative organisms were identified in 68 (18.9%) of 360 patients. , and were detected in 40 (11.1%), 14 (3.9%), and 28 (7.8%) of the patients, respectively. Patients 21-30 years of age represented more than one-third (37.8%) of positive patients. Of all patients, dual infections of and triple infection of were determined in 1.6% (6/360), 1.3% (5/360), 0.2% (1/360), and 0.2% (1/360) of the patients, respectively. In CT-, NG-, and MG-positive patients, different STI agents were also found such as HIV, HBV, HPV, HSV2, T. pallidum, and T. vaginalis. In conclusion, among and , CT was the most frequently detected bacterial cause of STDs in our hospital at Istanbul. Co-infections, which comprise more than one-fifth of the cases, should not be underestimated. Regular screening and following up of STD agents using multiplex real-time PCR-based diagnostic methods enabling the immediate detection of co-infections are essential for the treatment and primary prevention of STDs.
PubMed: 37046856
DOI: 10.3390/healthcare11070930 -
ACS Synthetic Biology Jul 2021The minimal gene set for life has often been theorized, with at least ten produced for (). Due to the difficulty of using in the lab, combined with its long...
The minimal gene set for life has often been theorized, with at least ten produced for (). Due to the difficulty of using in the lab, combined with its long replication time of 12-15 h, none of these theoretical minimal genomes have been tested, even with modern techniques. The publication of the whole-cell model provided the first opportunity to test them, simulating the genome edits . We simulated minimal gene sets from the literature, finding that they produced cells that did not divide. Using knowledge from previous research, we reintroduced specific essential and low essential genes ; enabling cellular division. This reinforces the need to identify species-specific low essential genes and their interactions. Any genome designs created using the currently incomplete and fragmented gene essentiality information will very likely require reintroductions to correct issues and produce dividing cells.
Topics: Genome, Bacterial; Models, Genetic; Mycoplasma genitalium
PubMed: 34111356
DOI: 10.1021/acssynbio.0c00515 -
Journal of Clinical Microbiology Oct 2021Mycoplasma genitalium is a sexually transmitted bacterium associated with nongonococcal urethritis (NGU) in men and cervicitis, endometritis, and pelvic inflammatory...
Mycoplasma genitalium is a sexually transmitted bacterium associated with nongonococcal urethritis (NGU) in men and cervicitis, endometritis, and pelvic inflammatory disease in women. Effective treatment is challenging due to the inherent, and increasingly acquired, antibiotic resistance in this pathogen. In our treatment trial conducted from 2007 to 2011 in Seattle, WA, we demonstrated poor efficacy of azithromycin (AZM) and doxycycline (DOX) against M. genitalium among men with NGU. In the present study, we cultured M. genitalium from 74 of 80 (92.5%) PCR-positive men at enrollment (V-1) and defined the MICs of AZM ( = 56 isolates) of DOX ( = 62 isolates). Susceptibility to AZM was bimodal; MICs were >8 μg/ml (44.6%) and <0.004 μg/ml (55.4%) for these isolates. The association of MIC with treatment efficacy was determined for men initially treated with either AZM ( = 30) or DOX ( = 24). Men treated with AZM were more likely to experience microbiologic treatment failure ( < 0.001) if infected with isolates that had AZM MICs of >8 μg/ml (18/18 men) than those with isolates that had AZM MICs of <0.004 μg/ml (1/12 men). Clinical treatment failure also was more likely to occur ( = 0.002) with AZM MICs of >8 μg/ml (12/18 men) than with AZM MICs of <0.004 μg/ml (1/12 men). In contrast, DOX MICs ranged from <0.125 to 2 μg/ml and were not correlated with microbiologic ( = 0.71) or clinical treatment ( = 0.41) failure, demonstrating no relationship between DOX MICs and treatment efficacy. Given the rapid spread of AZM resistance and the emergence of quinolone resistance, the current second-line therapy, monitoring MICs and evaluating other potential treatments for M. genitalium will be critical.
Topics: Anti-Bacterial Agents; Azithromycin; Doxycycline; Drug Resistance, Bacterial; Female; Humans; Male; Mycoplasma Infections; Mycoplasma genitalium; Treatment Outcome; Urethritis
PubMed: 34406799
DOI: 10.1128/JCM.00819-21 -
Journal of Medical Microbiology Sep 2021Failure of fluoroquinolones, the principal treatment option for macrolide-resistant infections, has recently emerged. This is of particular concern for men who have...
Failure of fluoroquinolones, the principal treatment option for macrolide-resistant infections, has recently emerged. This is of particular concern for men who have sex with men (MSM), who have high proportions of macrolide-resistant infections. Treatment failure with moxifloxacin is likely the result of single nucleotide polymorphisms (SNPs) in , whilst concurrent mutations may play a role. The levels of fluoroquinolone resistance and dual-class (i.e. macrolide and fluoroquinolone) resistance in among asymptomatic MSM is unknown. To (i) determine the proportion of fluoroquinolone resistance and dual-class resistance in infections among asymptomatic MSM, (ii) explore any clinical and behavioural associations with fluoroquinolone resistance, and (iii) determine the distribution of antibiotic resistance among sequence types (STs). positive samples (=94) were obtained from 1001 asymptomatic MSM enrolled in a study at Melbourne Sexual Health Centre (Carlton, Australia) between August 2016 and September 2017. Sanger sequencing was performed to determine the proportion of infections with SNPs in that have previously been associated with failure of moxifloxacin (corresponding to amino changes S83I, D83R, D87Y and D87N) and in (corresponding to amino acid changes M95I, D99N, D99Y and D99G). Associations between clinical/behavioural factors and SNPs were examined. Strain typing was performed by sequencing a portion of the gene. The proportion of MSM with infections harbouring and SNPs was 13.0 % [95 % confidence interval (CI): 6.8-23.2 %] and 4.7 % (95 % CI: 1.1-13.4 %), respectively; dual-class resistance was 13.0 %. No significant clinical/behavioural associations were found. Antibiotic resistance was not restricted to specific STs. One in eight (13 %) of asymptomatic MSM with had an infection with dual-class-resistance mutations. Typing by sequence suggested fluoroquinolone resistance is arising from independent mutation events. This study illustrates that asymptomatic MSM may act as a reservoir for antibiotic-resistant .
Topics: Anti-Bacterial Agents; DNA Gyrase; DNA Topoisomerase IV; DNA, Bacterial; Drug Resistance, Bacterial; Fluoroquinolones; Humans; Male; Mutation; Mycoplasma Infections; Mycoplasma genitalium; Polymerase Chain Reaction; Polymorphism, Single Nucleotide; Prevalence; Sexual and Gender Minorities
PubMed: 34590993
DOI: 10.1099/jmm.0.001429 -
Antibiotics (Basel, Switzerland) Oct 2021Mycoplasma infections are frequent in humans, as well as in a broad range of animals. However, antimicrobial treatment options are limited, partly due to the lack of a... (Review)
Review
Mycoplasma infections are frequent in humans, as well as in a broad range of animals. However, antimicrobial treatment options are limited, partly due to the lack of a cell wall in these peculiar bacteria. Both veterinary and human medicines are facing increasing resistance prevalence for the most commonly used drugs, despite different usage practices. To date, very few reviews have integrated knowledge on resistance to antimicrobials in humans and animals, the latest dating back to 2014. To fill this gap, we examined, in parallel, antimicrobial usage, resistance mechanisms and either phenotype or genotype-based methods for antimicrobial susceptibility testing, as well as epidemiology of resistance of the most clinically relevant human and animal mycoplasma species. This review unveiled common features and differences that need to be taken into consideration in a "One Health" perspective. Lastly, two examples of critical cases of multiple drug resistance are highlighted, namely, the human and the animal species, both of which can lead to the threat of untreatable infections.
PubMed: 34680797
DOI: 10.3390/antibiotics10101216