Laura G Matthews, Lenka A Vodstrcil, Natasha L Wild, Erica L Plummer, Ivette Aguirre, Kay Htaik, Gerald L Murray, Vesna De Petra, Michelle Sait, Norelle Sherry, Catriona S Bradshaw
{"title":"莫西沙星治疗生殖道支原体感染的疗效下降：氟喹诺酮类药物耐药性引导治疗的时间？","authors":"Laura G Matthews, Lenka A Vodstrcil, Natasha L Wild, Erica L Plummer, Ivette Aguirre, Kay Htaik, Gerald L Murray, Vesna De Petra, Michelle Sait, Norelle Sherry, Catriona S Bradshaw","doi":"10.1093/infdis/jiag251","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>We assessed trends in moxifloxacin-use and efficacy for MG over a decade at Melbourne Sexual Health Centre (MSHC). Specific Mycoplasma genitalium (MG) mutations, namely ParC-S83I, have been associated with moxifloxacin failure. In 2024 MSHC introduced ParC-S83 testing, recommending moxifloxacin for ParC-S83 wildtype infections and alternative regimens if the ParC-S83I mutation was detected. We present preliminary impacts of ParC-S83 testing on moxifloxacin-use and efficacy.</p><p><strong>Methods: </strong>Clients with MG from 2015-2024 were treated with doxycycline preceding macrolide-resistance guided azithromycin or moxifloxacin. Clients with a test-of-cure 14-90 days after completing moxifloxacin who reported >50% adherence and no condomless sex prior to test-of-cure were eligible for efficacy analyses. Proportions with 95% confidence intervals (CIs) were calculated for moxifloxacin-use and efficacy, with trends assessed by logistic regression. Moxifloxacin-use and efficacy were compared in the 12-months before and after introduction of the ParC-S83 assay.</p><p><strong>Results: </strong>From 2015-2024, 2,611/5,739 MG infections received moxifloxacin. Moxifloxacin-use increased from 6.7% (n=19/282; 95%CI:4.1-10.3%) in 2015 to 60.3% (n=482/800; 95%CI:56.8-63.7%) in 2023 (ptrend<0.0001). Efficacy analyses included 1,623 infections. Moxifloxacin-efficacy decreased from 100% (n=11/11) in 2015 to 79.3% (n=238/300, 95%CI:74.3-83.8%) in 2023 (ptrend=0.007). After introduction of the ParC-S83 assay, moxifloxacin-use decreased from 60.3% (n=482/800, 95%CI:56.8-63.7%) in 2023 to 49.2% (n=438/890, 95%CI:45.9-52.6%) in 2024 (p<0.0001) and cure increased from 79.3% (n=238/300, 95%CI:74.3-83.8%) in 2023 to 89.2% (n=116/130, 95%CI:82.6-94.0%, p=0.013) in ParC-S83 wildtype infections.</p><p><strong>Conclusions: </strong>Increasing moxifloxacin-use and declining efficacy reflects rising resistance in our region. Preliminary data suggests a ParC-S83 assay has the potential to improve moxifloxacin- use and cure in this setting.</p>","PeriodicalId":50179,"journal":{"name":"Journal of Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Declining efficacy of moxifloxacin for Mycoplasma genitalium infection: time for fluoroquinolone-resistance guided therapy?\",\"authors\":\"Laura G Matthews, Lenka A Vodstrcil, Natasha L Wild, Erica L Plummer, Ivette Aguirre, Kay Htaik, Gerald L Murray, Vesna De Petra, Michelle Sait, Norelle Sherry, Catriona S Bradshaw\",\"doi\":\"10.1093/infdis/jiag251\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>We assessed trends in moxifloxacin-use and efficacy for MG over a decade at Melbourne Sexual Health Centre (MSHC). Specific Mycoplasma genitalium (MG) mutations, namely ParC-S83I, have been associated with moxifloxacin failure. In 2024 MSHC introduced ParC-S83 testing, recommending moxifloxacin for ParC-S83 wildtype infections and alternative regimens if the ParC-S83I mutation was detected. We present preliminary impacts of ParC-S83 testing on moxifloxacin-use and efficacy.</p><p><strong>Methods: </strong>Clients with MG from 2015-2024 were treated with doxycycline preceding macrolide-resistance guided azithromycin or moxifloxacin. Clients with a test-of-cure 14-90 days after completing moxifloxacin who reported >50% adherence and no condomless sex prior to test-of-cure were eligible for efficacy analyses. Proportions with 95% confidence intervals (CIs) were calculated for moxifloxacin-use and efficacy, with trends assessed by logistic regression. Moxifloxacin-use and efficacy were compared in the 12-months before and after introduction of the ParC-S83 assay.</p><p><strong>Results: </strong>From 2015-2024, 2,611/5,739 MG infections received moxifloxacin. Moxifloxacin-use increased from 6.7% (n=19/282; 95%CI:4.1-10.3%) in 2015 to 60.3% (n=482/800; 95%CI:56.8-63.7%) in 2023 (ptrend<0.0001). Efficacy analyses included 1,623 infections. Moxifloxacin-efficacy decreased from 100% (n=11/11) in 2015 to 79.3% (n=238/300, 95%CI:74.3-83.8%) in 2023 (ptrend=0.007). After introduction of the ParC-S83 assay, moxifloxacin-use decreased from 60.3% (n=482/800, 95%CI:56.8-63.7%) in 2023 to 49.2% (n=438/890, 95%CI:45.9-52.6%) in 2024 (p<0.0001) and cure increased from 79.3% (n=238/300, 95%CI:74.3-83.8%) in 2023 to 89.2% (n=116/130, 95%CI:82.6-94.0%, p=0.013) in ParC-S83 wildtype infections.</p><p><strong>Conclusions: </strong>Increasing moxifloxacin-use and declining efficacy reflects rising resistance in our region. Preliminary data suggests a ParC-S83 assay has the potential to improve moxifloxacin- use and cure in this setting.</p>\",\"PeriodicalId\":50179,\"journal\":{\"name\":\"Journal of Infectious Diseases\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2026-05-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/infdis/jiag251\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/infdis/jiag251","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
Declining efficacy of moxifloxacin for Mycoplasma genitalium infection: time for fluoroquinolone-resistance guided therapy?
Background: We assessed trends in moxifloxacin-use and efficacy for MG over a decade at Melbourne Sexual Health Centre (MSHC). Specific Mycoplasma genitalium (MG) mutations, namely ParC-S83I, have been associated with moxifloxacin failure. In 2024 MSHC introduced ParC-S83 testing, recommending moxifloxacin for ParC-S83 wildtype infections and alternative regimens if the ParC-S83I mutation was detected. We present preliminary impacts of ParC-S83 testing on moxifloxacin-use and efficacy.
Methods: Clients with MG from 2015-2024 were treated with doxycycline preceding macrolide-resistance guided azithromycin or moxifloxacin. Clients with a test-of-cure 14-90 days after completing moxifloxacin who reported >50% adherence and no condomless sex prior to test-of-cure were eligible for efficacy analyses. Proportions with 95% confidence intervals (CIs) were calculated for moxifloxacin-use and efficacy, with trends assessed by logistic regression. Moxifloxacin-use and efficacy were compared in the 12-months before and after introduction of the ParC-S83 assay.
Results: From 2015-2024, 2,611/5,739 MG infections received moxifloxacin. Moxifloxacin-use increased from 6.7% (n=19/282; 95%CI:4.1-10.3%) in 2015 to 60.3% (n=482/800; 95%CI:56.8-63.7%) in 2023 (ptrend<0.0001). Efficacy analyses included 1,623 infections. Moxifloxacin-efficacy decreased from 100% (n=11/11) in 2015 to 79.3% (n=238/300, 95%CI:74.3-83.8%) in 2023 (ptrend=0.007). After introduction of the ParC-S83 assay, moxifloxacin-use decreased from 60.3% (n=482/800, 95%CI:56.8-63.7%) in 2023 to 49.2% (n=438/890, 95%CI:45.9-52.6%) in 2024 (p<0.0001) and cure increased from 79.3% (n=238/300, 95%CI:74.3-83.8%) in 2023 to 89.2% (n=116/130, 95%CI:82.6-94.0%, p=0.013) in ParC-S83 wildtype infections.
Conclusions: Increasing moxifloxacin-use and declining efficacy reflects rising resistance in our region. Preliminary data suggests a ParC-S83 assay has the potential to improve moxifloxacin- use and cure in this setting.
期刊介绍：
Published continuously since 1904, The Journal of Infectious Diseases (JID) is the premier global journal for original research on infectious diseases. The editors welcome Major Articles and Brief Reports describing research results on microbiology, immunology, epidemiology, and related disciplines, on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune responses. JID is an official publication of the Infectious Diseases Society of America.
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