Abstract:
Mycoplasma genitalium (M.genitalium) is associated with urethritis, cervicitis, pelvic inflammatory disease, proctitis and epididymitis. Its treatment is complicated by antimicrobial resistance. To assess clinicians\' adherence to M.genitalium diagnostic testing recommendations for syndromic presentations, as well as resistance-guided management of M.genitalium at Sydney Sexual Health Centre, we reviewed patients presenting between August and December 2018. 349/372 (94%) syndromic presentations were tested for M.genitalium with 16% M.genitalium test positivity and 81% macrolide resistance. 16/27 (59%) macrolide-sensitive infections and 65/77 (84%) macrolide-resistant infections received resistance-guided treatment. Tests of cure (TOCs) were unnecessarily ordered for 82% macrolide-sensitive cases, while 88% macrolide-resistant cases were correctly ordered TOCs. Co-existing STIs at the time of macrolide-sensitive (p = 0.30) or macrolide-resistant M.genitalium (p = 0.94) diagnosis did not significantly affect adherence to treatment guidelines. This study confirms the expected prevalence of M.genitalium and macrolide resistance in syndromic presentations while our real-world data highlight the decision-making challenges involved with managing M.genitalium, offering insights for further research.
摘要:
生殖支原体(M.生殖器)与尿道炎有关,宫颈炎,盆腔炎,直肠炎和附睾炎.其治疗因耐药性而复杂化。为了评估临床医生对综合征表现的生殖器分枝杆菌诊断测试建议的依从性,以及在悉尼性健康中心对生殖支原体进行抵抗指导的管理,我们回顾了2018年8月至12月期间就诊的患者.对349/372(94%)综合征表现进行了生殖支原体测试,其中生殖支原体测试阳性为16%,大环内酯耐药性为81%。16/27(59%)大环内酯敏感感染和65/77(84%)大环内酯耐药感染接受了耐药性指导治疗。82%的大环内酯敏感病例不必要地订购了治愈测试(TOC),而88%的大环内酯耐药病例是正确订购的TOC。在大环内酯敏感(p=0.30)或大环内酯耐药生殖支原体(p=0.94)诊断时共存的性传播感染并未显着影响对治疗指南的依从性。这项研究证实了综合征表现中生殖器M.和大环内酯耐药性的预期患病率,而我们的现实数据突出了管理生殖器M.为进一步的研究提供见解。