Evolving patterns of macrolide and fluoroquinolone resistance in Mycoplasma genitalium: an updated systematic review and meta-analysis

Teck-Phui Chua¹, Lenka A Vodstrcil², Gerald L Murray¹, Erica L Plummer³, Jørgen S Jensen⁴, Magnus Unemo⁵, Eric P F Chow⁶, Nicola Low⁷, David M Whiley⁸, Emma L Sweeney⁹, Jane S Hocking¹⁰, Jennifer A Danielewski¹¹, Suzanne M Garland¹, Christopher K Fairley², Lei Zhang¹², Catriona S Bradshaw¹³, Dorothy A Machalek¹⁴

Affiliations

¹ Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, VIC, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
² Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
³ Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
⁴ Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark.
⁵ WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Institute for Global Health, University College London, London, UK.
⁶ Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
⁷ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁸ The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Pathology Queensland Central Laboratory, Brisbane, QLD, Australia.
⁹ The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
¹⁰ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
¹¹ Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
¹² Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China.
¹³ Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia. Electronic address: catriona.bradshaw@monash.edu.
¹⁴ Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia. Electronic address: dmachalek@kirby.unsw.edu.au.

PMID: 40147462
DOI: 10.1016/j.lanmic.2024.101047

Free article

Meta-Analysis

Evolving patterns of macrolide and fluoroquinolone resistance in Mycoplasma genitalium: an updated systematic review and meta-analysis

Teck-Phui Chua et al. Lancet Microbe. 2025 Jul.

Free article

. 2025 Jul;6(7):101047.

doi: 10.1016/j.lanmic.2024.101047. Epub 2025 Mar 24.

Authors

Affiliations

¹ Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, VIC, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
² Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
³ Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
⁴ Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark.
⁵ WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Institute for Global Health, University College London, London, UK.
⁶ Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
⁷ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁸ The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Pathology Queensland Central Laboratory, Brisbane, QLD, Australia.
⁹ The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
¹⁰ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
¹¹ Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
¹² Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China.
¹³ Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia. Electronic address: catriona.bradshaw@monash.edu.
¹⁴ Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia. Electronic address: dmachalek@kirby.unsw.edu.au.

PMID: 40147462
DOI: 10.1016/j.lanmic.2024.101047

Abstract

Background: Over the past 5 years, since publication of the initial review, studies have provided additional data on macrolide and fluoroquinolone resistance in Mycoplasma genitalium, including data from regions previously lacking this information. We aimed to provide contemporary estimates of macrolide and fluoroquinolone resistance in M genitalium to inform national, regional, and global treatment guidelines.

Methods: This is an update of a previous systematic review and meta-analysis, which was performed up to Jan 7, 2019. In this update, we searched PubMed, Embase, and MEDLINE from Jan 1, 2018, to April 18, 2023, for published studies reporting macrolide, fluoroquinolone, or dual-class (macrolide and fluoroquinolone) resistance in M genitalium. Data were combined with the previous meta-analysis to examine resistance prevalence in M genitalium samples collected up to and including 2021. Random-effects meta-analyses were used to calculate summary estimates of prevalence. Subgroup analyses by WHO region and four time periods (before 2012 to 2018-21) were performed. This study was registered with PROSPERO, number CRD42021273340.

Findings: 166 studies (59 from the previous search period reporting data from M genitalium samples collected between 2003 and 2017, and 107 from the updated search period reporting data from M genitalium samples collected between 2005 and 2021) were included: 157 reporting macrolide resistance (41 countries; 22 974 samples), 89 reporting fluoroquinolone resistance (35 countries; 14 165 samples), and 74 reporting dual-class resistance (34 countries; 11 070 samples). In 2018-21, the overall prevalence of macrolide, fluoroquinolone, and dual-class resistance were 33·3% (95% CI 27·2-39·7), 13·3% (10·0-17·0), and 6·5% (4·0-9·4), respectively. Over time, there was a slight, although not statistically significant, decline in macrolide resistance in the Western Pacific and the Americas, but there was an increase in macrolide resistance in the European region. Fluoroquinolone resistance was highest in the Western Pacific and increased in the European non-Nordic region. ParC S83I was the most common variant associated with fluoroquinolone resistance, increasing from 0% (95% CI <0·0001-0·30) before 2012 to 7·3% (4·7-10·3) in 2018-21; p_trend=0·055.

Interpretation: Macrolide and fluoroquinolone resistance in M genitalium requires ongoing international surveillance, use of resistance assays for optimal antibiotic stewardship, and novel treatment options.

Funding: Australian Research Council.

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Conflict of interest statement

Declaration of interests T-PC received travel funding from the Henry and Rachel Ackman Travelling Scholarship (University of Melbourne), Rowden A E White Scholarship (University of Melbourne), and an Educational Grant (Sexual Health Society of Victoria) for presentation of preliminary results at the STI & HIV 2023 World Congress. LAV receives personal fees from the journal Sexually Transmitted Infections as an editorial fellow. ELP reports grants from the Jack Brockhoff Foundation for unrelated projects. JSJ reports personal fees from LeoPharma and Hologic; grants and non-financial support from Hologic, Freya, and Nabriva; and is on the board of Hologic, Nabriva, and Abbott Rapid Diagnostics. SMG reports personal fees from Merck. EPFC reports personal fees from Abbott Rapid Diagnostics and MSD. NL is on the board of Sefunda. DMW reports grants from SpeeDx for unrelated research. ELS reports personal fees from SpeeDx for unrelated research. CSB receives personal fees from Abbott Rapid Diagnostics.

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Evolving patterns of macrolide and fluoroquinolone resistance in Mycoplasma genitalium: an updated systematic review and meta-analysis

Affiliations

Evolving patterns of macrolide and fluoroquinolone resistance in Mycoplasma genitalium: an updated systematic review and meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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LinkOut - more resources

Full Text Sources

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