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Wu Y, Majidzadeh N, Li Y, Zafar Shakourzadeh M, Hajilari S, Kouhsari E, Azizian K. Trends of fluoroquinolones resistance in Mycoplasma and Ureaplasma urogenital isolates: Systematic review and meta-analysis. J Glob Antimicrob Resist 2024; 36:13-25. [PMID: 38016593 DOI: 10.1016/j.jgar.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Mycoplasma and Ureaplasma spp. especially M. hominis, U. parvum, and U. urealyticum recognized as an important cause of urogenital infections. Sake of the presence of antibiotic resistance and a continuous rise in resistance, the treatment options are limited, and treatment has become more challenging and costlier. OBJECTIVES Therefore, this meta-analysis aimed to estimate worldwide resistance rates of genital Mycoplasmas and Ureaplasma to fluoroquinolones (ciprofloxacin, ofloxacin, moxifloxacin, and levofloxacin) agents. METHODS We searched the relevant published studies in PubMed, Scopus, and Embase from until 3, March 2022. All statistical analyses were carried out using the statistical package R. RESULTS The 30 studies included in the analysis were performed in 16 countries. In the metadata, the proportions of ciprofloxacin, ofloxacin, moxifloxacin, and levofloxacin resistance in Mycoplasma and Ureaplasma urogenital isolates were reported 59.8% (95% CI 49.6, 69.1), 31.2% (95% CI 23, 40), 7.3% (95% CI 1, 31), and 5.3% (95% CI 1, 2), respectively. According to the meta-regression, the ciprofloxacin, ofloxacin, moxifloxacin, and levofloxacin rate increased over time. There was a statistically significant difference in the fluoroquinolones resistance rates between different continents/countries (P < 0.05). CONCLUSIONS Based on the results obtained in this systematic review and meta-analysis we recommend the use of the newer group of fluoroquinolones especially levofloxacin as the first choice for the treatment of genital mycoplasmosis, as well as ofloxacin for the treatment of genital infections caused by U. parvum.
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Affiliation(s)
- Yaping Wu
- Graduate School, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | | | - Ying Li
- Hangzhou TCM Hospital affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Matin Zafar Shakourzadeh
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran; Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sara Hajilari
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran; Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ebrahim Kouhsari
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Khalil Azizian
- Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Wen X, Nobakht MS, Yang Y, Kouhsari E, Hajilari S, Shakourzadeh MZ, Azizian K. Tetracyclines resistance in Mycoplasma and Ureaplasma urogenital isolates derived from human: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob 2023; 22:83. [PMID: 37697380 PMCID: PMC10496389 DOI: 10.1186/s12941-023-00628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/08/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Urogenital Mycoplasma infections are considered an important public health problem, owing to the presence of antibiotic resistance or decreased susceptibility, the treatment options are limited. OBJECTIVE Therefore, this meta-analysis aimed to estimate resistance rates of genital Mycoplasmas to tetracyclines (tetracycline, doxycycline, and minocycline). METHODS We searched the relevant published studies in PubMed, Scopus, and Embase until 3, March 2022. All statistical analyses were carried out using the statistical package R. RESULTS The 26 studies included in the analysis were performed in 15 countries. In the metadata, the proportions of tetracycline, doxycycline, and minocycline resistance in Mycoplasma and Ureaplasma urogenital isolates were reported 14.2% (95% CI 8.2-23.2%), 5% (95% CI 3-8.1%), and 11.9% (95% CI 6.3-21.5%), respectively. According to the meta-regression, the tetracycline and minocycline resistance rate decreased over time. Although, the doxycycline resistance rate increased over time. There was a statistically significant difference in the tetracyclines resistance rates between different continents/countries (P < 0.05). CONCLUSION The prevalence rate and antibiotic susceptibility profiles vary geographically. Therefore, rigorous or improved antimicrobial stewardship, contact tracing, and enhanced intensive surveillance systems are necessitated for preventing the emergence and further spreading of tetracyclines resistance in genital Mycoplasmas.
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Affiliation(s)
- Xiaoyan Wen
- Urology Department of Affiliated Hospital of Chengdu University, Chengdu, 610000, Sichuan, China.
| | - Mojgan Sarabi Nobakht
- Department of Microbiology, Faculty of Basic Sciences, Islamic Azad University, Sirjan Branch, Sirjan, Iran
| | - Yue Yang
- Urology Department of Affiliated Hospital of Chengdu University, Chengdu, 610000, Sichuan, China
| | - Ebrahim Kouhsari
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sara Hajilari
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Khalil Azizian
- Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Ye T, Chen B, Yu B, Zhong Q, Huang G, Hu X, Zhang W. Susceptibility of Ureaplasma urealyticum to Methylene Blue-Mediated Photodynamic Antimicrobial Chemotherapy: An in vitro Study. Photochem Photobiol 2015; 91:917-22. [PMID: 25688579 DOI: 10.1111/php.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/11/2015] [Indexed: 11/28/2022]
Abstract
The aim of this study was to detect the susceptibility of Ureaplasma urealyticum to methylene blue-mediated photodynamic antimicrobial chemotherapy (PACT). Three U. urealyticum strains including the standard serotype 1 and 5, and a clinically collected strain were used in this study. Strains were first incubated in 96-well culture plates in the presence of methylene blue with decreasing concentrations (from 1 to 0.015625 mg mL(-1)) for 20 or 60 min, and then submitted to irradiation with a light-emitting diode laser with a power density of 100 mW cm(-2) for 8, 17, 34 or 68 min. Regrowth of the strains was performed soon after irradiation. A significant inactivation effect was observed after PACT. Longer incubation time induced more extensive inactivation of U. urealyticum. No difference in response to PACT was observed between the two biovars of U. urealyticum. It was concluded that PACT had a significant inactivation effect on U. urealyticum, and it might be a promising alternative treatment for resistant U. urealyticum infections.
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Affiliation(s)
- Tinglu Ye
- Dermatology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Bancheng Chen
- Dermatology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Bo Yu
- Dermatology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qili Zhong
- Dermatology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Guoxin Huang
- Dermatology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaoping Hu
- Dermatology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wei Zhang
- Biomedical Research Institute, Shenzhen PKU-HKUST Medical Center, Shenzhen, China
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Ballard HO, Shook LA, Bernard P, Anstead MI, Kuhn R, Whitehead V, Grider D, Crawford TN, Hayes D. Use of azithromycin for the prevention of bronchopulmonary dysplasia in preterm infants: a randomized, double-blind, placebo controlled trial. Pediatr Pulmonol 2011; 46:111-8. [PMID: 20963840 DOI: 10.1002/ppul.21352] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/08/2010] [Accepted: 07/16/2010] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Since preventive therapies for bronchopulmonary dysplasia (BPD) are limited we treated preterm infants with azithromycin to decrease the incidence of BPD. METHODS Infants less than 1,250 g birth weight were randomized to azithromycin or placebo within 12 hr of beginning mechanical ventilation and within 72 hr of birth. The treatment group received azithromycin 10 mg/kg/day for 7 days followed by 5 mg/kg/day for a maximum of 6 weeks. Aspirates were collected during the study to assay for Ureaplasma. The primary endpoints were incidence of BPD or mortality. (Clinical Trials Identifier: NCT00319956.) RESULTS A total of 220 infants were enrolled (n=111 azithromycin, and 109 placebo). Mortality was 18% for the azithromycin group versus 22% for the placebo group (P = 0.45). Incidence of BPD was 76% for the azithromycin group versus 84% for the placebo group (P=0.2). The multiple logistic regression analysis demonstrated an odds ratio of 0.46 decrease in the chance of developing BPD or death for the azithromycin group, but was not statistically significant. The incidence of BPD in the Ureaplasma subgroup was 73% in the azithromycin group versus 94% in the placebo group (P=0.03). Analysis of patients in the Ureaplasma subgroup only, using the exact logistic model demonstrated a decrease in BPD or death in the azithromycin group with an estimated odds ratio of 0.026 (0.001-0.618, 95% confidence interval). CONCLUSIONS Routine use of azithromycin therapy for the prevention of BPD cannot be recommended. The early treatment of Ureaplasma colonized/infected patients might be beneficial, but a larger multi-centered trial is required to assess this more definitively.
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Lu C, Ye TL, Zhu GX, Feng PY, Ma H, Lu RB, Lai W. Phenotypic and Genetic Characteristics of Macrolide and Lincosamide Resistant Ureaplasma urealyticum Isolated in Guangzhou, China. Curr Microbiol 2009; 61:44-9. [DOI: 10.1007/s00284-009-9574-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 12/14/2009] [Indexed: 10/20/2022]
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Ballard HO, Anstead MI, Shook LA. Azithromycin in the extremely low birth weight infant for the prevention of bronchopulmonary dysplasia: a pilot study. Respir Res 2007; 8:41. [PMID: 17550598 PMCID: PMC1896160 DOI: 10.1186/1465-9921-8-41] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 06/05/2007] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Azithromycin reduces the severity of illness in patients with inflammatory lung disease such as cystic fibrosis and diffuse panbronchiolitis. Bronchopulmonary dysplasia (BPD) is a pulmonary disorder which causes significant morbidity and mortality in premature infants. BPD is pathologically characterized by inflammation, fibrosis and impaired alveolar development. The purpose of this study was to obtain pilot data on the effectiveness and safety of prophylactic azithromycin in reducing the incidence and severity of BPD in an extremely low birth weight (< or = 1000 grams) population. METHODS Infants < or = 1000 g birth weight admitted to the University of Kentucky Neonatal Intensive Care Unit (level III, regional referral center) from 9/1/02-6/30/03 were eligible for this pilot study. The pilot study was double-blinded, randomized, and placebo-controlled. Infants were randomized to treatment or placebo within 12 hours of beginning mechanical ventilation (IMV) and within 72 hours of birth. The treatment group received azithromycin 10 mg/kg/day for 7 days followed by 5 mg/kg/day for the duration of the study. Azithromycin or placebo was continued until the infant no longer required IMV or supplemental oxygen, to a maximum of 6 weeks. Primary endpoints were incidence of BPD as defined by oxygen requirement at 36 weeks gestation, post-natal steroid use, days of IMV, and mortality. Data was analyzed by intention to treat using Chi-square and ANOVA. RESULTS A total of 43 extremely premature infants were enrolled in this pilot study. Mean gestational age and birth weight were similar between groups. Mortality, incidence of BPD, days of IMV, and other morbidities were not significantly different between groups. Post-natal steroid use was significantly less in the treatment group [31% (6/19)] vs. placebo group [62% (10/16)] (p = 0.05). Duration of mechanical ventilation was significantly less in treatment survivors, with a median of 13 days (1-47 days) vs. 35 days (1-112 days)(p = 0.02). CONCLUSION Our study suggests that azithromycin prophylaxis in extremely low birth weight infants may effectively reduce post-natal steroid use for infants. Further studies are needed to assess the effects of azithromycin on the incidence of BPD and possible less common side effects, before any recommendations regarding routine clinical use can be made.
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Affiliation(s)
- Hubert O Ballard
- Pediatrics, University of Kentucky, 800 Rose Street, Lexington, KY40536, USA
| | - Michael I Anstead
- Pediatrics, University of Kentucky, 800 Rose Street, Lexington, KY40536, USA
| | - Lori A Shook
- Pediatrics, University of Kentucky, 800 Rose Street, Lexington, KY40536, USA
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Volgmann T, Ohlinger R, Panzig B. Ureaplasma urealyticum-harmless commensal or underestimated enemy of human reproduction? A review. Arch Gynecol Obstet 2005; 273:133-9. [PMID: 16044191 DOI: 10.1007/s00404-005-0030-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 04/28/2005] [Indexed: 11/26/2022]
Abstract
This article reviews the role, diagnosis and treatment of Ureaplasma infections in human reproduction.
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Affiliation(s)
- Thorsten Volgmann
- Department of Gynaecology and Obstetrics of the Ernst Moritz Arndt University, Wollweberstrasse 1, 17487, Greifswald, Germany.
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Ruef C. Klinische Bedeutung der Antibiotikaresistenz in Gynäkologie und Geburtshilfe. ACTA ACUST UNITED AC 2004; 45:19-27. [PMID: 15644637 DOI: 10.1159/000081713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Antibiotic resistance of microorganisms that cause infections of the urogenital tract is a clinically relevant problem in obstetrics and gynecology. Due to methodological difficulties, resistance testing is rarely used for the management of these infections. Therefore, solid epidemiological data on resistance rates of most involved pathogens are scarce. Antibiotic resistance of several microorganisms appears to be increasing in various areas of the world, mainly Trichomonas vaginalis and Gardnerella vaginalis (metronidazole),Streptococcus agalactiae (macrolides, clindamycin), Mycoplasma hominis (tetracyclines, intrinsically macrolide resistant). In addition,isolated cases of clinical infections caused by multi-resistant Chlamydia trachomatis have been reported. The presence of antibiotic resistance should therefore be considered in patients with an unfavorable course despite adequate antibiotic therapy. In light of the growing problem of antibiotic resistance and the large gaps in our knowledge in this particular area, research efforts in the field of anti-biotic resistance in gynecological infections should be markedly intensified.
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Affiliation(s)
- Christian Ruef
- Abteilung Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich, Zürich, Schweiz.
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