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Emergence of Mycoplasma genitalium with clinically significant fluoroquinolone resistance conferred by amino acid changes both in GyrA and ParC in Japan.

Abstract
We observed fluoroquinolone treatment failures in 2 men with Mycoplasma genitalium-positive non-gonococcal urethritis in Japan. A fluoroquinolone regimen of sitafloxacin 100 mg twice daily for 7 days failed to eradicate M. genitalium. In both cases, M. genitalium had fluoroquinolone resistance-associated amino acid changes both in GyrA and ParC and a macrolide resistance-associated mutation in the 23S rRNA gene. The emergence of such multi-drug resistant strains can threaten antimicrobial chemotherapy for M. genitalium infections in Japan, because we will lose the first- (azithromycin) and second-line (sitafloxacin) antimicrobial agents to treat M. genitalium infections. We prescribed an extended minocycline regimen of minocycline 100 mg twice daily for 14 days for our patients, and the regimen was successful in eradicating the M. genitalium. The extended minocycline regimen might be an option that we can try when treating multi-drug resistant M. genitalium infections in clinical practice.
AuthorsTakashi Deguchi, Shin Ito, Mitsuru Yasuda, Hiromi Kondo, Yoshiteru Yamada, Keita Nakane, Kosuke Mizutani, Tomohiro Tsuchiya, Shigeaki Yokoi, Masahiro Nakano
JournalJournal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (J Infect Chemother) Vol. 23 Issue 9 Pg. 648-650 (Sep 2017) ISSN: 1437-7780 [Electronic] Netherlands
PMID28462860 (Publication Type: Case Reports, Journal Article)
CopyrightCopyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Chemical References
  • Anti-Bacterial Agents
  • Fluoroquinolones
  • sitafloxacin
  • DNA Topoisomerase IV
  • DNA Gyrase
  • Minocycline
Topics
  • Amino Acid Substitution
  • Anti-Bacterial Agents (therapeutic use)
  • DNA Gyrase (genetics)
  • DNA Mutational Analysis
  • DNA Topoisomerase IV (genetics)
  • Drug Resistance, Bacterial (genetics)
  • Fluoroquinolones (pharmacology, therapeutic use)
  • Humans
  • Male
  • Middle Aged
  • Minocycline (therapeutic use)
  • Mycoplasma Infections (diet therapy, microbiology)
  • Mycoplasma genitalium (drug effects, genetics)
  • Retrospective Studies
  • Urethritis (drug therapy, microbiology)

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