Implementation of <i>Mycoplasma genitalium</i> Diagnostics with Macrolide-Resistance Detection Improves Patient Treatment Outcomes in Bulgaria
<b>Background/Objectives:</b> The increasing prevalence of <i>Mycoplasma genitalium</i> infections with macrolide-resistance, causing high azithromycin failure rates, is a major concern internationally. In response to this challenge, diagnostics that simultaneously detect <...
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2024-11-01
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| author | Ivva Philipova Maria Mademova Elena Birindjieva Venelina Milanova Viktoriya Levterova |
| author_facet | Ivva Philipova Maria Mademova Elena Birindjieva Venelina Milanova Viktoriya Levterova |
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| description | <b>Background/Objectives:</b> The increasing prevalence of <i>Mycoplasma genitalium</i> infections with macrolide-resistance, causing high azithromycin failure rates, is a major concern internationally. In response to this challenge, diagnostics that simultaneously detect <i>M. genitalium</i> and genetic markers for macrolide-resistance enable the therapy to be individually tailored, i.e., to implement resistance-guided therapy (RGT). This study aimed to evaluate patient treatment outcomes of <i>M. genitalium</i> therapy, guided by a macrolide-resistance assay in Bulgaria. <b>Methods:</b> Consecutively referred <i>M. genitalium</i> infection cases (<i>n</i> = 17) were analyzed for macrolide-resistance mutations (MRMs) and specific antimicrobial treatment was recommended accordingly (MRMs-negative infections received azithromycin and MRMs-positive infections received moxifloxacin). The treatment outcome based on test-of-cure was recorded, and the treatment failure rates and time to achieve a microbiological cure were compared to treatment outcomes in patients treated before the implementation of RGT. <b>Results</b>: Among patients given RGT (<i>n</i> = 17), the overall treatment failure rate was 1/17 (5.9%). This was significantly lower than the rate (47.6%) observed in patients treated pre-RGT (<i>p</i> = 0.002). The time to achieve a microbiological cure was 29.4 days (CI 24.5–34.3), compared to 45.2 days (CI 36.5–53.7) pre-RGT (<i>p</i> = 0.001). <b>Conclusions:</b> The implementation of <i>M. genitalium</i> diagnostics with macrolide-resistance detection improved treatment outcomes in Bulgaria, with significantly lower treatment failure rates and reduced time to achieve a microbiological cure. In light of the limited treatment options and concerns about their decreasing efficacy in response to misuse and overuse, a diagnostic macrolide-resistance assay is critical to direct the appropriate first-line treatment, to maintain the efficacy of antimicrobial treatment (antibiotic stewardship) and to minimize the spread of antimicrobial resistance. |
| format | Article |
| id | doaj-art-c93b69e641974524a0e884f51ee01e44 |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-c93b69e641974524a0e884f51ee01e442024-12-13T16:24:35ZengMDPI AGDiagnostics2075-44182024-11-011423266510.3390/diagnostics14232665Implementation of <i>Mycoplasma genitalium</i> Diagnostics with Macrolide-Resistance Detection Improves Patient Treatment Outcomes in BulgariaIvva Philipova0Maria Mademova1Elena Birindjieva2Venelina Milanova3Viktoriya Levterova4National Center of Infectious and Parasitic Diseases (NCIPD), 1504 Sofia, BulgariaFaculty of Biology, Sofia University St. Kliment Ohridski, 1164 Sofia, BulgariaCenter for Sexual Health CheckPoint Sofia, 1000 Sofia, BulgariaNational Center of Infectious and Parasitic Diseases (NCIPD), 1504 Sofia, BulgariaNational Center of Infectious and Parasitic Diseases (NCIPD), 1504 Sofia, Bulgaria<b>Background/Objectives:</b> The increasing prevalence of <i>Mycoplasma genitalium</i> infections with macrolide-resistance, causing high azithromycin failure rates, is a major concern internationally. In response to this challenge, diagnostics that simultaneously detect <i>M. genitalium</i> and genetic markers for macrolide-resistance enable the therapy to be individually tailored, i.e., to implement resistance-guided therapy (RGT). This study aimed to evaluate patient treatment outcomes of <i>M. genitalium</i> therapy, guided by a macrolide-resistance assay in Bulgaria. <b>Methods:</b> Consecutively referred <i>M. genitalium</i> infection cases (<i>n</i> = 17) were analyzed for macrolide-resistance mutations (MRMs) and specific antimicrobial treatment was recommended accordingly (MRMs-negative infections received azithromycin and MRMs-positive infections received moxifloxacin). The treatment outcome based on test-of-cure was recorded, and the treatment failure rates and time to achieve a microbiological cure were compared to treatment outcomes in patients treated before the implementation of RGT. <b>Results</b>: Among patients given RGT (<i>n</i> = 17), the overall treatment failure rate was 1/17 (5.9%). This was significantly lower than the rate (47.6%) observed in patients treated pre-RGT (<i>p</i> = 0.002). The time to achieve a microbiological cure was 29.4 days (CI 24.5–34.3), compared to 45.2 days (CI 36.5–53.7) pre-RGT (<i>p</i> = 0.001). <b>Conclusions:</b> The implementation of <i>M. genitalium</i> diagnostics with macrolide-resistance detection improved treatment outcomes in Bulgaria, with significantly lower treatment failure rates and reduced time to achieve a microbiological cure. In light of the limited treatment options and concerns about their decreasing efficacy in response to misuse and overuse, a diagnostic macrolide-resistance assay is critical to direct the appropriate first-line treatment, to maintain the efficacy of antimicrobial treatment (antibiotic stewardship) and to minimize the spread of antimicrobial resistance.https://www.mdpi.com/2075-4418/14/23/2665<i>Mycoplasma genitalium</i>diagnosticsmacrolide-resistance assayresistance-guided therapyBulgaria |
| spellingShingle | Ivva Philipova Maria Mademova Elena Birindjieva Venelina Milanova Viktoriya Levterova Implementation of <i>Mycoplasma genitalium</i> Diagnostics with Macrolide-Resistance Detection Improves Patient Treatment Outcomes in Bulgaria Diagnostics <i>Mycoplasma genitalium</i> diagnostics macrolide-resistance assay resistance-guided therapy Bulgaria |
| title | Implementation of <i>Mycoplasma genitalium</i> Diagnostics with Macrolide-Resistance Detection Improves Patient Treatment Outcomes in Bulgaria |
| title_full | Implementation of <i>Mycoplasma genitalium</i> Diagnostics with Macrolide-Resistance Detection Improves Patient Treatment Outcomes in Bulgaria |
| title_fullStr | Implementation of <i>Mycoplasma genitalium</i> Diagnostics with Macrolide-Resistance Detection Improves Patient Treatment Outcomes in Bulgaria |
| title_full_unstemmed | Implementation of <i>Mycoplasma genitalium</i> Diagnostics with Macrolide-Resistance Detection Improves Patient Treatment Outcomes in Bulgaria |
| title_short | Implementation of <i>Mycoplasma genitalium</i> Diagnostics with Macrolide-Resistance Detection Improves Patient Treatment Outcomes in Bulgaria |
| title_sort | implementation of i mycoplasma genitalium i diagnostics with macrolide resistance detection improves patient treatment outcomes in bulgaria |
| topic | <i>Mycoplasma genitalium</i> diagnostics macrolide-resistance assay resistance-guided therapy Bulgaria |
| url | https://www.mdpi.com/2075-4418/14/23/2665 |
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