Understanding the spread of de novo and transmitted macrolide-resistance in Mycoplasma genitalium.

Cadosch, Dominique; Garcia, Victor; Jensen, Jørgen S; Low, Nicola; Althaus, Christian L. (2020). Understanding the spread of de novo and transmitted macrolide-resistance in Mycoplasma genitalium. PeerJ, 8, e8913. PeerJ, Ltd 10.7717/peerj.8913

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Background The rapid spread of azithromycin resistance in sexually transmitted Mycoplasma genitalium infections is a growing concern. It is not yet clear to what degree macrolide resistance in M. genitalium results from the emergence of de novo mutations or the transmission of resistant strains. Methods We developed a compartmental transmission model to investigate the contribution of de novo macrolide resistance mutations to the spread of antimicrobial-resistant M. genitalium. We fitted the model to resistance data from France, Denmark and Sweden, estimated the time point of azithromycin introduction and the rates at which infected individuals receive treatment, and projected the future spread of resistance. Results The high probability of de novo resistance in M. genitalium accelerates the early spread of antimicrobial resistance. The relative contribution of de novo resistance subsequently decreases, and the spread of resistant infections in France, Denmark and Sweden is now mainly driven by transmitted resistance. If treatment with single-dose azithromycin continues at current rates, macrolide-resistant M. genitalium infections will reach 25% (95% confidence interval, CI [9-30]%) in France, 84% (95% CI [36-98]%) in Denmark and 62% (95% CI [48-76]%) in Sweden by 2025. Conclusions Blind treatment of urethritis with single-dose azithromycin continues to select for the spread of macrolide resistant M. genitalium. Clinical management strategies for M. genitalium should limit the unnecessary use of macrolides.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Cadosch, Dominique Richard; Garcia, Victor; Low, Nicola and Althaus, Christian


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




PeerJ, Ltd


[4] Swiss National Science Foundation




Andrea Flükiger-Flückiger

Date Deposited:

23 Apr 2020 20:06

Last Modified:

27 Apr 2020 15:26

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Antibiotic resistance Mathematical model Mycoplasma genitalium Sexually transmitted infection





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