Skip to main content
  • ASM
    • Antimicrobial Agents and Chemotherapy
    • Applied and Environmental Microbiology
    • Clinical Microbiology Reviews
    • Clinical and Vaccine Immunology
    • EcoSal Plus
    • Eukaryotic Cell
    • Infection and Immunity
    • Journal of Bacteriology
    • Journal of Clinical Microbiology
    • Journal of Microbiology & Biology Education
    • Journal of Virology
    • mBio
    • Microbiology and Molecular Biology Reviews
    • Microbiology Resource Announcements
    • Microbiology Spectrum
    • Molecular and Cellular Biology
    • mSphere
    • mSystems
  • Log in
  • My alerts
  • My Cart

Main menu

  • Home
  • Articles
    • Current Issue
    • Accepted Manuscripts
    • Archive
    • Minireviews
  • For Authors
    • Submit a Manuscript
    • Scope
    • Editorial Policy
    • Submission, Review, & Publication Processes
    • Organization and Format
    • Errata, Author Corrections, Retractions
    • Illustrations and Tables
    • Nomenclature
    • Abbreviations and Conventions
    • Publication Fees
    • Ethics Resources and Policies
  • About the Journal
    • About AAC
    • Editor in Chief
    • Editorial Board
    • For Reviewers
    • For the Media
    • For Librarians
    • For Advertisers
    • Alerts
    • RSS
    • FAQ
  • Subscribe
    • Members
    • Institutions
  • ASM
    • Antimicrobial Agents and Chemotherapy
    • Applied and Environmental Microbiology
    • Clinical Microbiology Reviews
    • Clinical and Vaccine Immunology
    • EcoSal Plus
    • Eukaryotic Cell
    • Infection and Immunity
    • Journal of Bacteriology
    • Journal of Clinical Microbiology
    • Journal of Microbiology & Biology Education
    • Journal of Virology
    • mBio
    • Microbiology and Molecular Biology Reviews
    • Microbiology Resource Announcements
    • Microbiology Spectrum
    • Molecular and Cellular Biology
    • mSphere
    • mSystems

User menu

  • Log in
  • My alerts
  • My Cart

Search

  • Advanced search
Antimicrobial Agents and Chemotherapy
publisher-logosite-logo

Advanced Search

  • Home
  • Articles
    • Current Issue
    • Accepted Manuscripts
    • Archive
    • Minireviews
  • For Authors
    • Submit a Manuscript
    • Scope
    • Editorial Policy
    • Submission, Review, & Publication Processes
    • Organization and Format
    • Errata, Author Corrections, Retractions
    • Illustrations and Tables
    • Nomenclature
    • Abbreviations and Conventions
    • Publication Fees
    • Ethics Resources and Policies
  • About the Journal
    • About AAC
    • Editor in Chief
    • Editorial Board
    • For Reviewers
    • For the Media
    • For Librarians
    • For Advertisers
    • Alerts
    • RSS
    • FAQ
  • Subscribe
    • Members
    • Institutions
Letter to the Editor

Long-Term Low Rate of Macrolide-Resistant Mycoplasma pneumoniae Strains in Germany

Roger Dumke, Thomas Ziegler
Roger Dumke
TU Dresden, Institut für Medizinische Mikrobiologie und Hygiene, Dresden, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Thomas Ziegler
Institut für Medizinische Diagnostik Berlin MVZ, Berlin, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
DOI: 10.1128/AAC.00455-19
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

LETTER

Mycoplasma pneumoniae is a frequent cause of infections of the lower and upper respiratory tracts of humans. During incidence peaks, which are reported at 3- to 7-year intervals, up to 40% of community-acquired pneumonia cases can be attributed to these bacteria (1). As species of the Mollicutes class lack the classical bacterial cell wall, M. pneumoniae is intrinsically resistant to all beta-lactam antibiotics. Furthermore, tetracyclines and quinolones are not recommended for children, who are the main patients affected by these infections. Therefore, macrolides are the first-line therapeutic agents for treatment of severe infections. Unfortunately, an increase in macrolide-resistant strains has been reported in many regions worldwide, critically narrowing the treatment options for pediatric patients. Resistance is based on mutations in domain V of the peptidyl transferase loop of the single copy of 23S rRNA of M. pneumoniae. More than 95% of resistant strains investigated worldwide show A-to-C/G/T transitions at position 2058 or 2059 (Escherichia coli numbering [2]). Previous studies confirmed a low rate of macrolide resistance in M. pneumoniae strains circulating in Germany (Table 1). However, different reports described not only regional differences in resistance rates but also relatively rapid change in these (3), requiring regular surveillance of clinical strains for adequate public health measurements.

View this table:
  • View inline
  • View popup
TABLE 1

Rates of macrolide-resistant strains of Mycoplasma pneumoniae in respiratory tract samples from patients in Germany

We retrospectively collected M. pneumoniae-positive DNA of respiratory tract samples from patients with symptoms of lower respiratory tract infections in different laboratories. Samples were taken between January 2016 and December 2018 in the eastern part (Dresden, Leipzig, and Berlin regions) of Germany. The 23S rRNA of M. pneumoniae was partially amplified and sequenced as described previously (4).

Among 166 samples tested, macrolide resistance was found in 5 specimens (Table 1) sampled in the years 2016 (2 samples), 2017 (2 samples), and 2018 (1 sample), respectively. All strains showed an A-to-G mutation at position 2059.

The low rate of M. pneumoniae resistance in Germany corresponds to the situation in other countries in central and northern Europe (5–7). Interestingly, a recent report from neighboring Switzerland demonstrated a rate of macrolide resistance of 9% (8) in samples in a tertiary-care hospital, suggesting differences between out- and inpatients. Four of the five macrolide-resistant strains found in the present study are from inpatients, supporting the hypothesis that not only more-severe cases but also cases with a history of unsuccessful antibiotic treatment may accumulate in hospitals. The constant rate of resistant strains over a period of more than 20 years suggests that resistant strains lack a competitive advantage in a human population moderately exposed to macrolides (9). Nevertheless, clinicians should be aware of treatment failures in a limited number of patients that can result from an infection with a resistant strain as well from the development of resistance in an initially susceptible strain during adequate antibiotic therapy (10). This seems a rare event among the samples of this report, or it is underestimated in clinical practice, as follow-up samples are not taken in most cases. Despite the limitations of the study, such as the missing demographic data of patients and lack of information about antibiotics prescribed during the course of infection, the results indicate continued low macrolide resistance among M. pneumoniae strains in Germany.

ACKNOWLEDGMENTS

We gratefully acknowledge the cooperation of independent laboratories (G. Ackermann, alphaomega Labor Delitzsch; A. Meye and C. Schönfels, Labor Ostsachsen Dresden and Görlitz, Germany).

The study was supported by a grant from the Robert-Koch-Institut, Berlin, Germany, for German reference laboratories.

  • Copyright © 2019 American Society for Microbiology.

All Rights Reserved.

REFERENCES

  1. 1.↵
    1. Waites KB,
    2. Xiao L,
    3. Liu Y,
    4. Balish MF,
    5. Atkinson TP
    . 2017. Mycoplasma pneumoniae from the respiratory tract and beyond. Clin Microbiol Rev 30:747–809. doi:10.1128/CMR.00114-16.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Pereyre S,
    2. Goret J,
    3. Bébéar C
    . 2016. Mycoplasma pneumoniae: current knowledge on macrolide resistance and treatment. Front Microbiol 7:974. doi:10.3389/fmicb.2016.00974.
    OpenUrlCrossRef
  3. 3.↵
    1. Tanaka T,
    2. Oishi T,
    3. Miyata I,
    4. Wakabayashi S,
    5. Kono M,
    6. Ono S,
    7. Kato A,
    8. Fukuda Y,
    9. Saito A,
    10. Kondo E,
    11. Teranishi H,
    12. Tanaka Y,
    13. Wakabayashi T,
    14. Akaike H,
    15. Ogita S,
    16. Ohno N,
    17. Nakano T,
    18. Terada K,
    19. Ouchi K
    . 2017. Macrolide-resistant Mycoplasma pneumoniae infection, Japan, 2008–2015. Emerg Infect Dis 23:1703–1706. doi:10.3201/eid2310.170106.
    OpenUrlCrossRef
  4. 4.↵
    1. Dumke R,
    2. Schnee C,
    3. Pletz MW,
    4. Rupp J,
    5. Jacobs E,
    6. Sachse K,
    7. Rohde G,
    8. Group CS
    , Capnetz Study Group. 2015. Epidemiological, clinical and genetic characteristics of epidemic Mycoplasma pneumoniae infections in relation to Chlamydia spp. infections in Germany. Emerg Infect Dis 21:426–434. doi:10.3201/eid2103.140927.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Spuesens EB,
    2. Meijer A,
    3. Bierschenk D,
    4. Hoogenboezem T,
    5. Donker GA,
    6. Hartwig NG,
    7. Koopmans MP,
    8. Vink C,
    9. van Rossum AM
    . 2012. Macrolide resistance determination and molecular typing of Mycoplasma pneumoniae in respiratory specimens collected between 1997 and 2008 in The Netherlands. J Clin Microbiol 50:1999–2004. doi:10.1128/JCM.00400-12.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Uldum SA,
    2. Bangsborg JM,
    3. Gahrn-Hansen B,
    4. Ljung R,
    5. Mølvadgaard M,
    6. Føns Petersen R,
    7. Wiid Svarrer C
    . 2012. Epidemic of Mycoplasma pneumoniae infection in Denmark, 2010 and 2011. Euro Surveill 17:20073. https://www.eurosurveillance.org/content/10.2807/ese.17.05.20073-en.
    OpenUrlPubMed
  7. 7.↵
    1. Gullsby K,
    2. Bondeson K
    . 2016. No detection of macrolide-resistant Mycoplasma pneumoniae from Swedish patients, 1996–2013. Infect Ecol Epidemiol 6:31374. doi:10.3402/iee.v6.31374.
    OpenUrlCrossRef
  8. 8.↵
    1. Wagner K,
    2. Imkamp F,
    3. Pires VP,
    4. Keller PM
    . 2018. Evaluation of the Lightmix Mycoplasma macrolide assay for the detection of macrolide resistant Mycoplasma pneumoniae in pneumonia patients. Clin Microbiol Infect 25:383.e5–383.e7. doi:10.1016/j.cmi.2018.10.006.
    OpenUrlCrossRef
  9. 9.↵
    1. Adriaenssens N,
    2. Coenen S,
    3. Versporten A,
    4. Muller A,
    5. Minalu G,
    6. Faes C,
    7. Vankerckhoven V,
    8. Aerts M,
    9. Hens N,
    10. Molenberghs G,
    11. Goossens H
    , ESAC Project Group. 2011. European Surveillance of Antimicrobial Consumption (ESAC): outpatient macrolide, lincosamide and streptogramin (MLS) use in Europe (1997–2009). J Antimicrob Chemother 66:vi37–vi45. doi:10.1093/jac/dkr456.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Dumke R,
    2. Stolz S,
    3. Jacobs E,
    4. Juretzek T
    . 2014. Molecular characterization of macrolide resistance of a Mycoplasma pneumoniae strain that developed during therapy of a patient with pneumonia. Int J Infect Dis 29:197–199. doi:10.1016/j.ijid.2014.07.014.
    OpenUrlCrossRef
  11. 11.
    1. Dumke R,
    2. von Baum H,
    3. Lück PC,
    4. Jacobs E
    . 2010. Occurrence of macrolide-resistant Mycoplasma pneumoniae strains in Germany. Clin Microbiol Infect 16:613–616. doi:10.1111/j.1469-0691.2009.02968.x.
    OpenUrlCrossRefPubMedWeb of Science
  12. 12.
    1. Dumke R,
    2. Lück C,
    3. Jacobs E
    . 2013. Low rate of macrolide resistance in Mycoplasma pneumoniae strains in Germany between 2009 and 2012. Antimicrob Agents Chemother 57:3460. doi:10.1128/AAC.00706-13.
    OpenUrlFREE Full Text
PreviousNext
Back to top
Download PDF
Citation Tools
Long-Term Low Rate of Macrolide-Resistant Mycoplasma pneumoniae Strains in Germany
Roger Dumke, Thomas Ziegler
Antimicrobial Agents and Chemotherapy Apr 2019, 63 (5) e00455-19; DOI: 10.1128/AAC.00455-19

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Print

Alerts
Sign In to Email Alerts with your Email Address
Email

Thank you for sharing this Antimicrobial Agents and Chemotherapy article.

NOTE: We request your email address only to inform the recipient that it was you who recommended this article, and that it is not junk mail. We do not retain these email addresses.

Enter multiple addresses on separate lines or separate them with commas.
Long-Term Low Rate of Macrolide-Resistant Mycoplasma pneumoniae Strains in Germany
(Your Name) has forwarded a page to you from Antimicrobial Agents and Chemotherapy
(Your Name) thought you would be interested in this article in Antimicrobial Agents and Chemotherapy.
Share
Long-Term Low Rate of Macrolide-Resistant Mycoplasma pneumoniae Strains in Germany
Roger Dumke, Thomas Ziegler
Antimicrobial Agents and Chemotherapy Apr 2019, 63 (5) e00455-19; DOI: 10.1128/AAC.00455-19
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Top
  • Article
    • LETTER
    • ACKNOWLEDGMENTS
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

KEYWORDS

Mycoplasma pneumoniae

Related Articles

Cited By...

About

  • About AAC
  • Editor in Chief
  • Editorial Board
  • Policies
  • For Reviewers
  • For the Media
  • For Librarians
  • For Advertisers
  • Alerts
  • RSS
  • FAQ
  • Permissions
  • Journal Announcements

Authors

  • ASM Author Center
  • Submit a Manuscript
  • Article Types
  • Ethics
  • Contact Us

Follow #AACJournal

@ASMicrobiology

       

ASM Journals

ASM journals are the most prominent publications in the field, delivering up-to-date and authoritative coverage of both basic and clinical microbiology.

About ASM | Contact Us | Press Room

 

ASM is a member of

Scientific Society Publisher Alliance

Copyright © 2019 American Society for Microbiology | Privacy Policy | Website feedback

Print ISSN: 0066-4804; Online ISSN: 1098-6596