Increasing macrolide treatment failure in women with Mycoplasma genitalium in a public hospital
ESC Congress Library. Wani S. May 4, 2016; 127040; A-215 Disclosure(s): NIL
Dr. Saima Wani
Dr. Saima Wani
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Abstract
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BACKGROUND

Mycoplasma genitalium (MG) has been implicated in the aetiology of urethritis, cervicitis, pelvic inflammatory disease and adverse pregnancy outcomes. Increasing rates of resistance to first line macrolide antibiotic, azithromycin has been reported worldwide. An audit was undertaken at the Royal Women's Hospital, Victoria Australia, to determine the rate of MG treatment failure and a subset of which were also evaluated for macrolide resistance markers. MG testing commenced at the Royal Women's in 2009. All women who presented to the Pregnancy Advisory Service were screened for MG prior to surgical or medical termination of pregnancy and in 2013 this testing expanded to other areas of the hospital.

 

METHOD

We conducted a retrospective audit on 10,441 samples sent for molecular detection of Mycoplasma genitalium at The Royal Women's Hospital, Victoria between Jan 2014 to Oct 2015.

Selected MG positive samples were analysed for 23S rRNA gene single nucleotide polymorphism (SNP), associated with higher rate of resistance, using high resolution melt. Samples were sent for resistance testing where the results would determine future management of these patients.

We also audited a period between Aug 2009 to Dec 2010 with 1636 women tested for MG. During this period, resistance testing was not available. However, response to treatment was monitored by a test of cure at 4-6 weeks post treatment.

RESULTS

Overall 239 (2.3%) samples were positive for MG between Jan 2014 to Oct 2015. Among the 52 of the 239 (21.8%) positive samples evaluated for mutation in the 23rRNA gene, 25 samples had mutation associated with macrolide resistance (48%, [95% CI-34%-61%]).

In our earlier audit (Aug 2009 to Dec 2010) 74 women (4.5% [CI 3.5-5.6]) were positive for MG. One hundred percent of the 55 women had no treatment failures with azithromycin in this period as determined by negative test of cure. The remaining 19 women (26%) were lost to follow up.

CONCLUSION

Our standard management of MG is azithromyin as the 2009-2010 audit showed 100% success rate in treatment with no failures in the 55 women who had a test of cure. However our recent audit showed a macrolide resistance mutation in 48% of samples sent for resistance testing. This suggests we can no longer recommend azithromycin as first line therapy. Second line therapy with quinolones presents challenges in a population with a high proportion of pregnant women and emerging reports of resistance.

 

 

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