生殖支原体耐药及机制研究进展

Research Progress in Drug Resistance Related Mechanism of Mycoplasma Genitalium

生殖支原体是男性非淋球菌性尿道炎的独立致病菌之一。其体外分离培养十分困难,相应的诊断和治疗药物监测手段受到限制。生殖支原体的体外药物敏感性方法从传统的琼脂稀释法及肉汤稀释法,发展为细胞培养法,且随着分子生物技术的发展也在不断改进。生殖支原体对阿奇霉素会出现耐药,其耐药机制主要是23S rRNAⅤ区的基因突变并可能与L22和L4核糖体蛋白基因突变有关。最近,不断出现二线药物莫西沙星治疗失败的案例,其耐药机制可能与拓扑异构酶Ⅳpar C亚基的基因突变有关。临床上快速出现的对一线、二线抗菌药抵抗的生殖支原体,甚至是多重耐药生殖支原体,更加大了治疗难度。对生殖支原体耐药机制的探讨及寻找新的更有效的药物成为研究热点。

Mycoplasma genitalium is one kind of pathogens that causes non-gonococcal urethritis in men.As a fastidious bacterium,Mycoplasma genitalium is very difficult and time-consuming to isolate and culture from clinical specimes.The methods of the corresponding diagnosis and clinical therapeutic drug monitoring are limited.The antimicrobial susceptibility tests for Mycoplasma genitalium including broth dilution,agar dilution method and cell culture,are developing with molecular biological diagnostic technology continuously.The azithromycin resistance in Mycoplasma genitalium may occur,and the main mechanisms are mutations in domain Ⅴ of 23S rRNA and mutations in ribosomal protein genes of L4 and L22.Recently,failure of moxifloxacin treatment in Mycoplasma genitalium infections occurred frequently.The resistance might be caused by mutations in the topoisomerase Ⅳ par C subunit gene.It will make it much harder to treat Mycoplasma genitalium infections,after the rapid appearance of the first-line,second-line or even multiple antimicrobial-resistant Mycoplasma genitalium.The discussion on the mechanism of drug resistances and seeking for new and more effective drugs have become the focuses of the study.