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Antibiotics
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Antibiotic Resistance of Sexually Transmitted Pathogens
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Antibiotic Resistance of Sexually Transmitted Pathogens

A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 9905

Special Issue Editor

Dr. Luis Piñeiro

E-Mail Website
Guest Editor
Microbiology Department, Donostia University Hospital-Biodonostia Health Research Institute, Osakidetza, San Sebastian, Spain
Interests: chlamydia trachomatis; mycoplasma genitalium; bacterial pathogens; antimicrobial defense

Special Issue Information

Dear Colleagues,

Antibiotic resistance of sexually transmitted pathogens is an increasing problem in the management of sexually transmitted infections (STIs), which has motivated notable modifications in the last update of the STI treatment guidelines of the Centers for Disease Control and Prevention in July 2021. The emergence of Neisseria gonorrhoeae ceftriaxone-resistant strains, the growing trends of azithromycin-resistant rates in Mycoplasma genitalium, the treatment failures of Chlamydia trachomatis infection due to reinfection or to the infrequent but described macrolide-resistant cases, the healthcare overload in some STI care centers that attend to risk patients with recurrent STIs with several previous antibiotic treatment regimens and/or with an insufficient contact tracing of their sexual partners, secondary effects or different adherence rates depending on the treatment regimen, and the unequal availability of diagnostic tools in different geographic areas are some of the variables in the actual context of the management of STIs.

In this context, to choose the most suitable empirical treatment, it is important to take into account the different types of STI risk population (general, bridge, or core) with different rates described of antibiotic resistance. In the same way, to implement a guided treatment, the availability of diagnostic techniques is needed to obtain a rapid syndromic diagnosis of the main bacterial STIs and to analyze the presence of macrolide resistance-associated mutations in M. genitalium infections. Finally, the epidemiologic surveillance of the antibiotic resistance rates in each geographic area, or the molecular characterization of the circulating bacterial strains, will enhance the knowledge of the trends in antibiotic resistances allowing new updates and improvements in the recommendations for the management of STIs.

In this Special Issue, we would like to count on your experience in this field to share the results of your latest studies.

Dr. Luis Darío Piñeiro
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • STI management
  • antibiotic resistance

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Published Papers (4 papers)

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Research

12 pages, 327 KiB  
Article
Phenotypic and Genotypic Antimicrobial Susceptibility Testing of Chlamydia trachomatis Isolates from Patients with Persistent or Clinical Treatment Failure in Spain
by Laura Villa, José Antonio Boga, Luis Otero, Fernando Vazquez, Ana Milagro, Paula Salmerón, Martí Vall-Mayans, María Dolores Maciá, Samuel Bernal and Luis Piñeiro
Antibiotics 2023, 12(6), 975; https://doi.org/10.3390/antibiotics12060975 - 28 May 2023
Cited by 2 | Viewed by 2231
Abstract
The aim of this multicentre project (seven hospitals across the Spanish National Health Service) was to study the phenotypic and genotypic susceptibility of C. trachomatis to the main antimicrobials used (macrolides, doxycycline, and quinolones) in isolates from patients with clinical treatment failure in [...] Read more.
The aim of this multicentre project (seven hospitals across the Spanish National Health Service) was to study the phenotypic and genotypic susceptibility of C. trachomatis to the main antimicrobials used (macrolides, doxycycline, and quinolones) in isolates from patients with clinical treatment failure in whom reinfection had been ruled out. During 2018–2019, 73 clinical isolates were selected. Sixty-nine clinical specimens were inoculated onto confluent McCoy cell monolayers for phenotypic susceptibility testing. The minimum inhibitory concentration for azithromycin and doxycycline was defined as the lowest concentration associated with an at least 95% reduction in inclusion-forming units after one passage in the presence of the antibiotic compared to the initial inoculum for each strain (control). Sequencing analysis was performed for the genotypic detection of resistance to macrolides, analysing mutations in the 23S rRNA gene (at positions 2057, 2058, 2059, and 2611), and quinolones, analysing a fragment of the gyrA gene, and searching for the G248T mutation (Ser83->Ile). For tetracyclines, in-house RT-PCR was used to test for the tet(C) gene. The phenotypic susceptibility testing was successful for 10 isolates. All the isolates had minimum inhibitory concentrations for azithromycin ≤ 0.125 mg/L and for doxycycline ≤ 0.064 mg/L and were considered sensitive. Of the 73 strains studied, no mutations were found at positions T2611C or G248T of the gyrA gene. We successfully sequenced 66 isolates. No macrolide resistance-associated mutations were found at positions 2057, 2058, 2059, or T2611C. None of the isolates carried the tet(C) gene. We found no evidence for genomic resistance in this large, clinically relevant dataset. Full article
(This article belongs to the Special Issue Antibiotic Resistance of Sexually Transmitted Pathogens)
15 pages, 3911 KiB  
Article
Azithromycin Susceptibility Testing and Molecular Investigation of Neisseria gonorrhoeae Isolates Collected in Russia, 2020–2021
by Ilya Kandinov, Boris Shaskolskiy, Dmitry Kravtsov, Alexandra Vinokurova, Sofya Gorshkova, Alexey Kubanov, Victoria Solomka, Julia Shagabieva, Dmitry Deryabin, Ekaterina Dementieva and Dmitry Gryadunov
Antibiotics 2023, 12(1), 170; https://doi.org/10.3390/antibiotics12010170 - 13 Jan 2023
Cited by 5 | Viewed by 2692
Abstract
The aim of this work was to study the resistance to macrolides (azithromycin) in the modern Russian population of N. gonorrhoeae with the analysis of genetic resistance determinants. Azithromycin is not used to treat gonococcal infection in Russia. However, among 162 isolates collected [...] Read more.
The aim of this work was to study the resistance to macrolides (azithromycin) in the modern Russian population of N. gonorrhoeae with the analysis of genetic resistance determinants. Azithromycin is not used to treat gonococcal infection in Russia. However, among 162 isolates collected in 2020–2021, 22 isolates (13.6%) were phenotypically resistant to azithromycin. Mutations in 23S rRNA genes were found only in two isolates; erm and mefA genes were absent. Azithromycin resistance was shown to be predominantly associated with mutations in the mtrR and mtrD genes of the MtrCDE efflux pump and their mosaic alleles which may have formed due to a horizontal transfer from N. meningitidis. A total of 30 types of mtrR alleles and 10 types of mtrD alleles were identified including mosaic variants. Matching between the mtrR and mtrD alleles was revealed to indicate the cooperative molecular evolution of these genes. A link between the mtrR and mtrD alleles and NG-MAST types was found only for NG-MAST 228 and 807, typical of N. gonorrhoeae in Russia. The high level of resistance to azithromycin in Russia may be related to the spread of multiple transferable resistance to antimicrobials regardless of their use in the treatment of gonococcal infection. Full article
(This article belongs to the Special Issue Antibiotic Resistance of Sexually Transmitted Pathogens)
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11 pages, 261 KiB  
Article
Increases in the Macrolide Resistance of Mycoplasma genitalium and the Emergence of the A2058T Mutation in the 23S rRNA Gene: Clonal Spread?
by Luis Piñeiro, Pedro Idigoras, Maitane Arrastia, Ayla Manzanal, Iñigo Ansa and Gustavo Cilla
Antibiotics 2022, 11(11), 1492; https://doi.org/10.3390/antibiotics11111492 - 27 Oct 2022
Cited by 2 | Viewed by 1927
Abstract
The management of Mycoplasma genitalium sexually transmitted infection (STI) is hindered by increasing resistance to the recommended antibiotics, macrolides and quinolones, worldwide. In Gipuzkoa (Basque Country, Spain), macrolide and quinolone resistance rates in 2014–2018 were reported as <20% and <10%, respectively. The aims [...] Read more.
The management of Mycoplasma genitalium sexually transmitted infection (STI) is hindered by increasing resistance to the recommended antibiotics, macrolides and quinolones, worldwide. In Gipuzkoa (Basque Country, Spain), macrolide and quinolone resistance rates in 2014–2018 were reported as <20% and <10%, respectively. The aims of this study were to compare these rates with those in 2019–2021 and analyse the genetic and epidemiological features of the strains and cases associated with striking changes in the resistance trends. Resistance to macrolides (n = 1019) and quinolones (n = 958) was studied, analysing mutations in 23S rRNA and parC/gyrA genes, respectively. The rate of macrolide resistance increased from 17.3% in 2014–2018 to 32.1% in 2019–2021, as much in the more prevalent A2058/2059G mutations (16.6–27.8%) as in the emergent A2058T mutations (0.5–4.1%) but with differences in the odds ratios and the relative risk increase between A2058T and A2058/2059G mutations. MG191 adhesin and MG309 lipoprotein of the 27 emergent strains detected with A2058T mutations were amplified, sequenced, and typed using phylogenetic and variable number tandem repeat analysis, respectively. Genetic clonal spread was ruled out, but most of the A2058T cases were men who had sex with men (24/27) with a history of STI and antibiotic treatments (19/27). No changes were observed in quinolone resistance trends, but the rate of resistance to both antibiotics rose from 2.9% to 8.3%, especially in cases with A2058T mutations. The genetic characterisation of strains and epidemiological surveillance of cases are needed to detect populations at increased risk of treatment failure in this infection. Full article
(This article belongs to the Special Issue Antibiotic Resistance of Sexually Transmitted Pathogens)
12 pages, 2608 KiB  
Article
Tolerance to Ceftriaxone in Neisseria gonorrhoeae: Rapid Induction in WHO P Reference Strain and Detection in Clinical Isolates
by Margaux Balduck, Jolein Gyonne Elise Laumen, Saïd Abdellati, Irith De Baetselier, Tessa de Block, Sheeba Santhini Manoharan-Basil and Chris Kenyon
Antibiotics 2022, 11(11), 1480; https://doi.org/10.3390/antibiotics11111480 - 26 Oct 2022
Cited by 7 | Viewed by 2221
Abstract
In addition to antimicrobial resistance, bacteria contain other mechanisms to survive antibiotic exposure such as tolerance, defined as the ability to slow metabolism by the extension of the lag phase without altering antimicrobial susceptibility. In a number of bacterial species, tolerance has been [...] Read more.
In addition to antimicrobial resistance, bacteria contain other mechanisms to survive antibiotic exposure such as tolerance, defined as the ability to slow metabolism by the extension of the lag phase without altering antimicrobial susceptibility. In a number of bacterial species, tolerance has been associated with treatment failure and infection chronicity and is found to precede and facilitate antimicrobial resistance. It is unknown if tolerance can be induced in Neisseria gonorrhoeae. In this study, we determined if tolerance to ceftriaxone (CRO) can be induced in N. gonorrhoeae and detected in clinical isolates. To induce tolerance, WHO P N. gonorrhoeae reference strain samples were grown under daily 3 h intermittent CRO exposure (10× the MIC), partitioned by overnight growth in GC broth. This cyclic exposure was performed for 7 consecutive days in sextuplicate, with two control cultures to which GC medium without antibiotics was added. To detect tolerance and assess CRO susceptibility, modified Tolerance Disc (TD) and Epsilometer tests were performed on isolates after each CRO exposure cycle. Additionally, this experiment was carried out on 18 clinical N. gonorrhoeae isolates. Tolerance was first detected after two CRO exposure cycles in five out of six samples. The phenotype differed per cycle with no clear pattern. No tolerance was found in control samples but was detected in 10 out of 18 clinical isolates. The present study is the first to demonstrate the induction of tolerance to CRO in N. gonorrhoeae through antibiotic exposure. In addition, tolerance to CRO was found in clinical samples. Full article
(This article belongs to the Special Issue Antibiotic Resistance of Sexually Transmitted Pathogens)
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