PT  - JOURNAL ARTICLE
AU  - Dominique Cadosch
AU  - Victor Garcia
AU  - Christian L. Althaus
AU  - Jørgen Skov Jensen
AU  - Nicola Low
TI  - De novo mutations drive the spread of macrolide-resistant <em>Mycoplasma genitalium</em>: a mathematical modelling study
AID  - 10.1101/321216
DP  - 2018 Jan 01
TA  - bioRxiv
PG  - 321216
4099  - http://biorxiv.org/content/early/2018/08/28/321216.short
4100  - http://biorxiv.org/content/early/2018/08/28/321216.full
AB  - 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 analyzed epidemiological data and developed a compartmental model to investigate the contribution of de novo macrolide resistance mutations to the spread of antimicrobial-resistant M. genitalium. We fitted the model to data from France, Denmark and Sweden and estimated treatment rates of infected individuals and the time point of azithromycin introduction.Results We found a high probability of de novo resistance (12%, 95% CI 8–17%), which is responsible for the observed rapid spread of antimicrobial resistant M. genitalium. The estimated per capita treatment rate in France was lower than in Denmark and Sweden but confidence intervals for the three estimates overlap. The estimated dates of introduction of azithromycin in each country are consistent with published reports.Conclusions Since de novo resistance is the main driver of macrolide resistance in M. genitalium, blind treatment of urethritis with azithromycin is not recommended. Clinical management strategies for M. genitalium should limit the unnecessary use of macrolides.