Frontiers in cellular and infection microbiology · 2026
Towards precision management of Mycoplasma genitalium: a real-world cohort study identifying key predictors for treatment failure and the superiority of sequential therapy.
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Qiu Xinmin, Chen Baobing, Chen Jianping, Li Xinzheng, Tian Jiyun
Аннотация
BACKGROUND: The management of Mycoplasma genitalium (MG) infection is challenged by rising macrolide resistance, leading to high failure rates with azithromycin. Evidence on the long-term effectiveness of alternative initial regimens, particularly sequential therapy, and easily obtainable predictors for poor outcomes remains scarce.
METHODS: We conducted a retrospective cohort study at a tertiary hospital in China (2018-2024). Sexually active adults with nucleic acid amplification test (NAAT)-confirmed MG infection and available treatment records were included. The primary outcomes were treatment failure (persistent infection at 8 weeks, ultimate failure) and recurrence. Multivariable logistic regression and Kaplan-Meier survival analyses were employed to assess the impact of initial antibiotic regimens (azithromycin, quinolones, doxycycline-quinolone sequential therapy), demographics, and co-infections.
RESULTS: Among 1, 192 MG-positive patients, 474 completed follow-up. After adjustment, doxycycline-quinolone sequential therapy was associated with significantly lower odds of ultimate treatment failure (adjusted odds ratio [aOR]=0.36, 95%CI:0.21-0.61) and recurrence (aOR=0.37, 95%CI:0.18-0.75) compared to azithromycin. Survival analysis confirmed a faster median time to clearance with sequential therapy (7 vs. 10 weeks, p=0.001) and a marked "long-tail" effect in the azithromycin group (mean clearance time: 94.2 vs. 28.0 weeks). Co-infection with Chlamydia trachomatis (CT) was the strongest independent predictor for all adverse outcomes (aOR for ultimate failure=3.21, 95%CI:1.88-5.48), followed by male sex.
CONCLUSIONS: In this real-world cohort, doxycycline-quinolone sequential therapy demonstrated superior long-term effectiveness over azithromycin for MG infection. CT co-infection and male sex were key risk predictors. These findings advocate for a paradigm shift towards risk-stratified initial therapy, prioritizing sequential regimens for high-risk patients to improve cure rates while supporting antimicrobial stewardship.
METHODS: We conducted a retrospective cohort study at a tertiary hospital in China (2018-2024). Sexually active adults with nucleic acid amplification test (NAAT)-confirmed MG infection and available treatment records were included. The primary outcomes were treatment failure (persistent infection at 8 weeks, ultimate failure) and recurrence. Multivariable logistic regression and Kaplan-Meier survival analyses were employed to assess the impact of initial antibiotic regimens (azithromycin, quinolones, doxycycline-quinolone sequential therapy), demographics, and co-infections.
RESULTS: Among 1, 192 MG-positive patients, 474 completed follow-up. After adjustment, doxycycline-quinolone sequential therapy was associated with significantly lower odds of ultimate treatment failure (adjusted odds ratio [aOR]=0.36, 95%CI:0.21-0.61) and recurrence (aOR=0.37, 95%CI:0.18-0.75) compared to azithromycin. Survival analysis confirmed a faster median time to clearance with sequential therapy (7 vs. 10 weeks, p=0.001) and a marked "long-tail" effect in the azithromycin group (mean clearance time: 94.2 vs. 28.0 weeks). Co-infection with Chlamydia trachomatis (CT) was the strongest independent predictor for all adverse outcomes (aOR for ultimate failure=3.21, 95%CI:1.88-5.48), followed by male sex.
CONCLUSIONS: In this real-world cohort, doxycycline-quinolone sequential therapy demonstrated superior long-term effectiveness over azithromycin for MG infection. CT co-infection and male sex were key risk predictors. These findings advocate for a paradigm shift towards risk-stratified initial therapy, prioritizing sequential regimens for high-risk patients to improve cure rates while supporting antimicrobial stewardship.