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Park: Letter to the Editor: Breakpoints of the Mycoplasma Hominis and Ureaplasma Urealyticum
Letter to the Editor

Yonsei Medical Journal 2017; 58(6): 1252.

Published online: 28 September 2017

DOI: https://doi.org/10.3349/ymj.2017.58.6.1252

Letter to the Editor: Breakpoints of the Mycoplasma Hominis and Ureaplasma Urealyticum

Hyun Soo Park

Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea.

Corresponding author: Dr. Hyun Soo Park, Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea. Tel: 82-31-961-7367, Fax: 82-31-961-7182, hsparkmd@gmail.com

Received 14 June 2017

© Copyright: Yonsei University College of Medicine 2017

Yonsei University College of Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Lee, et al.1 reported the prevalence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in pregnant women. They used Mycoplasma IST-2 kit (bioMerieux, Marcy-l'Etoile, France) for the identification and antibiotics susceptibility testing. In the article, the breakpoints were defined as tetracycline S≤4, R≥8; doxycycline S≤4, R≥8; azithromycin S≤0.12, R≥4; clarithromycin S≤1, R≥4; erythromycin S≤1, R≥4; josamycin S≤2, R≥8; ciprofloxacin S≤1, R≥2; ofloxacin S≤1, R≥4; and pristinamycin R≥2. However, there was no reference attached to the paragraph. As Mycoplasma hominis is intrinsically resistant to the C14 and C15 macrolides and azalides such as erythromycin and azithromycin, and Ureaplasma species also have natural resistance to clindamycin and other lincosamides,2 it is not rational to apply the same breakpoints for same antibiotics to each organism.
In October 2011, Clinical and Laboratory Standards Institute (CLSI) issued the document M43-A with the title of ‘Methods for Antimicrobial Susceptibility Testing for Human Mycoplasmas; Approved Guideline.’3 In the document, guidelines for performance, interpretation, and quality control of in vitro broth microdilution and agar dilution susceptibility for antimicrobials against Mycoplasma hominis and Ureaplasma urealyticum were first described by CLSI. There are breakpoints for selected antibiotics such as quinolones, tetracyclines, lincosamides, macrolides, and ketolides. Each organism has unique profiles of antibiotics susceptibilities which are different from those used in Mycoplasma IST-2 kit. We do not know how the manufacturer set up the breakpoints for the antimicrobial susceptibility test kit. However, as we now have criteria and methods proposed by CLSI, they should be used. It has been more than five years since CLSI issued the M43-A document. However, there still are many commercially available kits that do not comply with the CLSI minimal inhibitory concentration interpretive criteria for genital Mycoplasmas. As the test results using those kits may be misleading, they should not be used in clinical setting.

Notes

The authors have no financial conflicts of interest.

References

1. Lee MY, Kim MH, Lee WI, Kang SY, Jeon YL. Prevalence and antibiotic susceptibility of mycoplasma hominis and ureaplasma urealyticum in pregnant women. Yonsei Med J. 2016; 57:1271–1275.
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2. Waites KB, Duffy LB, Bébéar CM, Matlow A, Talkington DF, Kenny GE, et al. Standardized methods and quality control limits for agar and broth microdilution susceptibility testing of mycoplasma pneumoniae, mycoplasma hominis, and ureaplasma urealyticum. J Clin Microbiol. 2012; 50:3542–3547.
crossref
3. CLSI. Methods for antimicrobial susceptibility testing of human mycoplasmas; approved guideline. CLSI document M43-A. Wayne, PA: Clinical and Laboratory Standards Institute;2011.
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