Abstract：
OBJECTIVE: British guidelines advise treatment of Mycoplasma genitalium (Mgen) infection using the results of macrolide resistance-associated mutation (MRAM) assays. Limited data informs management when patients fail MRAM-guided treatment. This study evaluates current management strategies employed for cases of Mgen infection with MRAM-guided treatment failure.
METHODS: This retrospective analysis reviewed laboratory and clinical data pertaining to all positive Mgen results between 28 May 2020 and 05 November 2022 across three London sexual health clinics. Treatment failure was defined as microbiological or clinical failure, despite appropriate MRAM-guided treatment with full compliance and no re-infection risk. Where MRAM status was unable to be determined, samples were excluded.
RESULTS: 340 samples were included from mostly male (74.4%) patients with a mean age of 30 years. The majority of tests were sent for urethritis (63.8%), and most infections were present without concurrent STIs (83.5%). 183 (53.8%) samples were MRAM positive; 157 (46.1%) were wild type. 152/183 (83.1%) received MRAM-guided treatment. 49/152 (32.2%) cases of MRAM-guided treatment failure were identified. 32/49 (65.3%) achieved either microbiological or clinical cure through a variety of treatment regimens. 66.6% of nine patients who received pristinamycin achieved microbiological cure; two patients were cured by minocycline. Many patients received multiple courses of moxifloxacin despite previous failures.
CONCLUSIONS: Whilst high compliance with recommended MRAM-guided therapy was identified, there were also high rates of quinolone therapy failure (32.2%). Barriers to appropriate treatment include a lack of quinolone resistance assays and the non-availability of sitafloxacin in Europe, along with the limited availability of pristinamycin and minocycline in the UK during the study dates. We recommend developing a standardised management pathway for treatment resistant cases.
METHODS: This retrospective analysis reviewed laboratory and clinical data pertaining to all positive Mgen results between 28 May 2020 and 05 November 2022 across three London sexual health clinics. Treatment failure was defined as microbiological or clinical failure, despite appropriate MRAM-guided treatment with full compliance and no re-infection risk. Where MRAM status was unable to be determined, samples were excluded.
RESULTS: 340 samples were included from mostly male (74.4%) patients with a mean age of 30 years. The majority of tests were sent for urethritis (63.8%), and most infections were present without concurrent STIs (83.5%). 183 (53.8%) samples were MRAM positive; 157 (46.1%) were wild type. 152/183 (83.1%) received MRAM-guided treatment. 49/152 (32.2%) cases of MRAM-guided treatment failure were identified. 32/49 (65.3%) achieved either microbiological or clinical cure through a variety of treatment regimens. 66.6% of nine patients who received pristinamycin achieved microbiological cure; two patients were cured by minocycline. Many patients received multiple courses of moxifloxacin despite previous failures.
CONCLUSIONS: Whilst high compliance with recommended MRAM-guided therapy was identified, there were also high rates of quinolone therapy failure (32.2%). Barriers to appropriate treatment include a lack of quinolone resistance assays and the non-availability of sitafloxacin in Europe, along with the limited availability of pristinamycin and minocycline in the UK during the study dates. We recommend developing a standardised management pathway for treatment resistant cases.
摘要：
目的：英国指南建议使用大环内酯耐药相关突变（MRAM）检测结果治疗生殖支原体（Mgen）感染。当患者MRAM指导的治疗失败时，有限的数据告知管理层。这项研究评估了MRAM指导的治疗失败的Mgen感染病例的当前管理策略。
方法：这项回顾性分析回顾了2020年5月28日至2022年11月5日期间伦敦三家性健康诊所所有Mgen阳性结果的实验室和临床数据。治疗失败定义为微生物或临床失败，尽管在MRAM指导下进行了适当的治疗，但完全合规且无再感染风险。如果无法确定MRAM状态，样本被排除在外。
结果：340个样本主要来自男性（74.4%）患者，平均年龄为30岁。大多数检查是针对尿道炎(63.8%),并且大多数感染存在，而没有并发性传播感染（83.5％）。183个(53.8%)样品为MRAM阳性;157个(46.1%)为野生型。152/183（83.1%）接受MRAM引导治疗。确定了49/152（32.2％）例MRAM指导的治疗失败。32/49（65.3％）通过多种治疗方案实现了微生物或临床治愈。接受普立霉素治疗的9例患者中有66.6％实现了微生物治愈；两名患者被米诺环素治愈。尽管以前失败，许多患者仍接受了多疗程的莫西沙星。
结论：虽然确定了对推荐的MRAM指导治疗的高依从性，喹诺酮治疗的失败率也很高(32.2%).适当治疗的障碍包括缺乏喹诺酮耐药性测定和在欧洲无法获得西他沙星，在研究日期期间，普里斯霉素和米诺环素在英国的可用性有限。我们建议为耐药病例开发标准化的管理途径。
方法：这项回顾性分析回顾了2020年5月28日至2022年11月5日期间伦敦三家性健康诊所所有Mgen阳性结果的实验室和临床数据。治疗失败定义为微生物或临床失败，尽管在MRAM指导下进行了适当的治疗，但完全合规且无再感染风险。如果无法确定MRAM状态，样本被排除在外。
结果：340个样本主要来自男性（74.4%）患者，平均年龄为30岁。大多数检查是针对尿道炎(63.8%),并且大多数感染存在，而没有并发性传播感染（83.5％）。183个(53.8%)样品为MRAM阳性;157个(46.1%)为野生型。152/183（83.1%）接受MRAM引导治疗。确定了49/152（32.2％）例MRAM指导的治疗失败。32/49（65.3％）通过多种治疗方案实现了微生物或临床治愈。接受普立霉素治疗的9例患者中有66.6％实现了微生物治愈；两名患者被米诺环素治愈。尽管以前失败，许多患者仍接受了多疗程的莫西沙星。
结论：虽然确定了对推荐的MRAM指导治疗的高依从性，喹诺酮治疗的失败率也很高(32.2%).适当治疗的障碍包括缺乏喹诺酮耐药性测定和在欧洲无法获得西他沙星，在研究日期期间，普里斯霉素和米诺环素在英国的可用性有限。我们建议为耐药病例开发标准化的管理途径。
