Alarming rise in antibiotic-resistant urogenital infections in Greece, study shows escalating resistance trends

In a recent study published in The Journal of Antibiotics, a group of researchers analyzed the trends in antimicrobial resistance among urogenital Mycoplasma hominis (M. hominis) and Ureaplasma species in Greece, utilizing 2,992 Ureaplasma spp. and 371 M. hominis isolates from 2014 to 2022, assessing their sensitivity to various antibiotics.

Study: Antimicrobial resistance rates of urogenital Mycoplasma hominis and Ureaplasma species before and during the COVID-19 pandemic: results from a Greek survey, 2014 to 2022. Image Credit: Fahroni/Shutterstock.com

Background 

M. hominis and Ureaplasma species, part of the Mollicutes group, are notable for their lack of a cell wall, making them undetectable by Gram staining and nesessitating polymerase chain reaction (PCR) for diagnosis.

They include many species of organisms commonly inhabiting the genital track and believed to contribute to certain urological infections and pregnancy complications. Nevertheless, it is difficult to differentiate between colonization and infection.

These pathogens have a unique cell structure that makes them resistant to penicillin or other drugs targeting cell wall synthesis, relying instead on agents that interfere with protein synthesis or topoisomerases.

Of recent interest is the rising resistance to these therapies, generating great apprehension among clinicians. The mechanisms of antibiotic resistance in Ureaplasma spp. and M. hominis are not fully understood, and further studies are necessary to assess the impact of antibiotic overuse and the efficacy of current treatment regimens.

About the study 

The present study's methods involved a retrospective descriptive analysis of medical laboratory records from the 'Bioiatriki' Healthcare Center and Leto General Maternity and Gynecology Clinic S.A. in Athens, Greece.

The data spanned from 2014 to 2022 for Ureaplasma spp. and from 2016 to mid-2022 for M. hominis. The subjects included symptomatic patients with genito-urethral complaints and asymptomatic individuals undergoing regular genital healthcare screening.

Universal flexible cotton swabs were utilized to collect clinical samples from different sites of  males, such as urethra, urine, semen, expressed prostatic secretions; female samples were obtained from the cervix, urethra, and urine.

After four hours, these samples were cultured aerobically for a period of 48 hours in an incubator set at 37 degrees Celsius using a Mycoplasma DUO kit. Red discoloration from yellow, without disrupting a medium cloud development, indicated mycoplasma species. The SIR Mycoplasma kit tested Antibiotic sensitivity in U9 or arginine broth for U. urealyticum or M. hominis.

Tested antibiotics included azithromycin, josamycin, doxycycline, tetracycline, erythromycin, clindamycin, pristinamycin, and ofloxacin. Mycoplasma grew, generating ammonia that changed the medium to alkaline which caused discoloration of the medium. When the microorganisms were sensitive to the tested antibiotics, metabolism was inhibited, and the medium remained yellow.

Descriptive statistics were used in data analysis, with results expressed as frequencies and percentages of resistance for given age categories and annual resistance per antimicrobial agent. Graphic representation of trends in antimicrobial resistance from 2014 to 2022 showed changes within the stipulated period.

Susceptibility, intermediate resistance, and resistance proportions for M. hominis and Ureaplasma spp. were included in the sensitivity analysis across the various antibiotics.

Study results 

In the study, a total of 2,992 Ureaplasma spp. Isolates and 371 M. hominis isolates were analyzed from 2014 to 2022. The results showed notable trends in antimicrobial resistance for both pathogens.

Ureaplasma spp. had high susceptibility to doxycycline, azithromycin, pristinamycin, tetracycline, and josamycin, with intermediate susceptibility to erythromycin. However, a dramatic increase in resistance to clindamycin was noted, rising from 60% in 2014 to a highest of 98.46% in 2021. Additionally, erythromycin resistance escalated from 9.54% in 2018 to 22.13% in 2021.

M. hominis exhibited a different resistance pattern, with consistently high resistance rates to erythromycin. The resistance to azithromycin also significantly increased over time, from 52.78% in 2017 to 97.22% in 2022. This trend is particularly alarming given the general reliance on these antibiotics for treatment.

The study highlighted the escalating issue of antibiotic-resistant urogenital mycoplasmas and ureaplasmas in Greece, raising concerns about antibiotic overconsumption.

The observed trends suggest a need for effective control measures, including proper antibiotic stewardship policies, nationwide surveillance systems, and appropriate culture-based therapy policies to manage this emerging risk.

The data also underscored the importance of continuously monitoring and reporting resistance patterns to guide clinical decision-making.

The significant increase in resistance to commonly used antibiotics, such as clindamycin and erythromycin, points to the urgent need to develop new therapeutic strategies and guidelines to effectively treat infections caused by these pathogens.

The study's findings are crucial for understanding the evolving resistance patterns and informing public health strategies to combat the growing threat of antimicrobial resistance in the region.

Conclusions 

To summarize, this research is one of the largest assessments of antimicrobial resistance patterns of Ureaplasma and Mycoplasma in the genitourinary tract.

It was observed that, despite the high use of azithromycin during the COVID-19 pandemic, the rates of resistance to azithromycin and erythromycin against Ureaplasma spp. remained low.

However, erythromycin and azithromycin resistance against M. hominis remained high. Most Ureaplasma isolates demonstrated high susceptibility to several antibiotics, while M. hominis showed high resistance to erythromycin and azithromycin. This resistance could be attributed to the overconsumption of antibiotics. 

Written by

Vijay Kumar Malesu

Vijay holds a Ph.D. in Biotechnology and possesses a deep passion for microbiology. His academic journey has allowed him to delve deeper into understanding the intricate world of microorganisms. Through his research and studies, he has gained expertise in various aspects of microbiology, which includes microbial genetics, microbial physiology, and microbial ecology. Vijay has six years of scientific research experience at renowned research institutes such as the Indian Council for Agricultural Research and KIIT University. He has worked on diverse projects in microbiology, biopolymers, and drug delivery. His contributions to these areas have provided him with a comprehensive understanding of the subject matter and the ability to tackle complex research challenges.