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Kweon, Lim, Oh, Kim, Choe, Lee, Cho, and Lee: Prevalence and Antimicrobial Susceptibility of Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum in Individuals With or Without Symptoms of Genitourinary Infections
Original Article

Lab Med Online 2016;6(2):79-87.

Published online: 20 April 2016

DOI: https://doi.org/10.3343/lmo.2016.6.2.79

Prevalence and Antimicrobial Susceptibility of Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum in Individuals With or Without Symptoms of Genitourinary Infections

Oh Joo Kweon, M.D.1, Yong Kwan Lim, M.D.1, Se Min Oh, M.D.1, Tae-Hyoung Kim, M.D.2, Hyun-Sop Choe, M.D.3, Seung-Ju Lee, M.D.3, Yong-Hyun Cho, M.D.4, Mi-Kyung Lee, M.D.1,

1Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea

2Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea

3Department of Urology, St. Vincent's Hospital, the Catholic University of Korea, Suwon, Korea

4Department of Urology, St. Mary's Hospital, the Catholic University of Korea, Seoul, Korea

Corresponding author: Mi-Kyung Lee Department of Laboratory Medicine, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel: +82-2-6299-2719, Fax: +82-2-6298-8630, E-mail: cpworld@cau.ac.kr

Received 14 May 2015       Revised 2 June 2015       Accepted 2 June 2015

Copyright © 2016 The Korean Society for Laboratory Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The aim of this study was to determine the prevalence and antimicrobial susceptibility of Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum among patients displaying symptoms of genitourinary infections and asymptomatic volunteers.

Methods

Genitourinary samples were collected from 897 participants (365 symptomatic patients and 532 asymptomatic volunteers). The samples were analyzed using multiplex real-time PCR (AnyplexTM II, Seegene, Korea), multiplex PCR (Seeplex®, Seegene), and Mycoplasma IST 2 Kit (bioMerieux, France).

Results

The prevalence of M. hominis, U. urealyticum, and U. parvum in the genitourinary samples of symptomatic patients compared with asymptomatic volunteers was 9.9% vs. 5.5%, 12.3% vs. 9.0%, and 36.4% vs. 30.8%, respectively. After eliminating cases of co-infections with other pathogens, there was a significant difference in the prevalence of M. hominis between symptomatic patients and asymptomatic volunteers (9.1% vs. 5.2%, P<0.05), but not in the prevalence of U. urealyticum and U. parvum organisms. When tested for antimicrobial susceptibility, more than 95.5% of each species were susceptible to tetracycline, doxycycline, josamycin, and pristamycin. More than 78.9% of Ureaplasma spp. were susceptible to azithromycin, erythromycin, and clarithromycin; however less than 4.2% of M. hominis were susceptible to these antibiotics. When tested with ofloxacin and ciprofloxacin, 40.9–58.9% and 9.1–25.0% of the three species were susceptible to these drugs, respectively.

Conclusions

M. hominis is the leading causative pathogen for genitourinary infection; however the involvement of Ureaplasma spp. is debatable. For optimal antimicrobial therapy, the accurate detection of these organisms and determination of antimicrobial susceptibility is crucial considering their diverse antimicrobial susceptibility patterns.

Keywords: Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, Genitourinary, Prevalence, Antimicrobial susceptibility

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Table 1.
The prevalence of Mycoplasma hominis and Ureaplasma species according to the type of specimens, sex, and symptom (including overlapping results)
Species Symptoms Total Male Female
Entire specimens Specimens without other pathogens∗ Urine Endocervical swab Urine
+ – P value + – P value + – P value + –
(N=365) (N=532) (N=341) (N=522) (N=164) (N=346) (N=186) (N=201)
MH No. 36 29   31 27   5 8   22 30
% 9.9 5.5 <0.01 9.1 5.2 <0.01 3.1 2.3 0.56 11.8 14.9
UU No. 45 48   33 48   21 31   19 22
% 12.3 9.0 <0.01 9.7 9.2 0.81 13.0 8.9 0.16 10.2 11.0
UP No. 133 164   117 150   24 63   103 107
% 36.4 30.8 <0.01 34.3 28.7 0.10 14.9 18.1 0.45 55.4 53.2

∗ Including Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium.

Abbreviations: MH, Mycoplasma hominis; UU, Ureaplasma urealyticum; UP, Ureaplasma parvum.

Table 2.
Antimicrobial susceptibility patterns of Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum
Species     DOT JOS OFL ERY TET CIP AZI CLA PRI
MH (N=24) S No. 24 23 13 0 24 6 1 0 23
  % 100.0 95.8 54.2 0 100.0 25.0 4.2 0 95.8
I No. 0 0 4 1 0 8 5 2 –
  % 0 0 16.7 4.2 0 33.3 20.8 8.3 –
R No. 0 1 7 23 0 10 18 22 1
  % 0 4.2 29.2 95.8 0 41.7 75.0 91.7 4.2
UU (N=22) S No. 21 22 9 19 21 2 18 20 22
  % 95.5 100.0 40.9 86.4 95.5 9.1 81.8 90.9 100.0
I No. 0 0 11 2 0 5 2 1 –
  % 0 0 50.0 9.1 0 22.7 9.1 4.5 –
R No. 1 0 2 1 1 15 2 1 0
  % 4.5 0 9.1 4.5 4.5 68.2 9.1 4.5 0
UP (N=95) S No. 93 95 56 75 91 17 81 79 95
  % 97.9 100.0 58.9 78.9 95.8 17.9 85.3 83.2 100.0
I No. 1 0 27 8 2 48 4 5 –
  % 1.1 0 28.4 8.4 2.1 50.5 4.2 5.3 –
R No. 1 0 12 12 2 30 10 11 0
  % 1.1 0 12.6 12.6 2.1 31.6 10.5 11.6 0
Ureaplasma spp. (N=131) S No. 128 131 70 102 126 19 108 108 131
  % 97.7 100.0 53.4 77.9 96.2 14.5 82.4 82.4 100.0
I No. 1 0 46 12 2 54 8 7 –
  % 0.8 0 35.1 9.2 1.5 41.2 6.1 5.3 –
R No. 2 0 15 17 3 58 15 16 0
  % 1.5 0 11.5 13.0 2.3 44.3 11.5 12.2 0

The breakpoints (mg/L) are as follows: DOT S≤4, R≥8; JOS S≤2 R≥8; OFL S≤1, R≥4; ERY S≤1, R≥4; TET S≤4, R≥8; CIP S≤1, R≥2; AZI S≤0.12, R≥4; CLA S≤1, R≥4; PRI R≥2. Abbreviations: MH, Mycoplasma hominis; UU, Ureaplasma urealyticum; UP, Ureaplasma parvum; DOT, Doxycycline; JOS, Josamycin; OFL, Ofloxacin; ERY, Erythromycin; TET, Tetracycline; CIP, Ciprofloxacin; AZI, Azithromycin; CLA, Clarithromycin; PRI, Pristamycin; S, Susceptible; I, Intermediate; R, Resistant.

Table 3.
Antimicrobial susceptibility patterns of each microorganism according to the symptoms from all types of specimens
Species Symptoms DOT JOS OFL ERY TET CIP AZI CLA PRI
+ – + – + – + – + – + – + – + – + –
MH S (%) 1 100.0 1 00.0 95.0 1 100.0 55.0 50.0 0.0 0.0 100.0 1 100.0 20.0 25.0 0.0 0.0 0.0 0.0 95.0 100.0
I (%) 0.0 0.0 0.0 0.0 15.0 25.0 5.0 0.0 0.0 0.0 35.0 25.0 20.0 25.0 5.0 25.0 0.0 –
R (%) 0.0 0.0 5.0 0.0 30.0 25.0 95.0 1 100.0 0.0 0.0 45.0 25.0 80.0 50.0 95.0 75.0 5.0 0.0
UU S (%) 91.7 1 00.0 100.0 1 100.0 16.7∗ 70.0∗ 83.3 90.0 91.7 1 100.0 0.0 20.0 75.0 90.0 91.7 90.0 100.0 100.0
I (%) 0.0 0.0 0.0 0.0 66.7 30.0 16.7 0.0 0.0 0.0 8.3 40.0 16.7 0.0 8.3 0.0 0.0 –
R (%) 8.3 0.0 0.0 0.0 16.7 0.0 0.0 10.0 8.3 0.0 91.7∗ 40.0∗ 8.3 10.0 0.0 10.0 0.0 0.0
UP S (%) 1 100.0 93.8 100.0 1 100.0 57.1 62.5 71.4∗ 93.8∗ 98.4 90.6 12.7 28.1 77.8∗ 1 00.0∗ 82.5 84.4 100.0 100.0
I (%) 0.0 3.1 0.0 0.0 28.6 28.1 11.1 3.1 0.0 6.3 52.4 46.9 6.3 0.0 17.5 15.6 0.0 –
R (%) 0.0 3.1 0.0 0.0 14.3 9.4 17.5 3.1 1.6 3.1 34.9 25.0 15.9∗ 0.0∗ 0.0 0.0 0.0 0.0
Ureaplasma spp. S (%) 98.8 95.6 100.0 1 100.0 48.8 62.2 69.8∗ 93.3∗ 97.7 93.3 9.3∗ 24.4∗ 74.4∗ 97.8∗ 81.4 84.4 100.0 100.0
I (%) 0.0 2.2 0.0 0.0 37.2 31.1 12.8 2.2 0.0 4.4 40.7 42.2 9.3 0.0 12.7 13.3 0.0 –
R (%) 1.2 2.2 0.0 0.0 14.0 6.7 17.4 4.4 2.3 2.2 50.0 33.3 16.3∗ 2.2∗ 5.8 2.2 0.0 0.0

The breakpoints (mg/L) are as follows; DOT S≤4, R≥8; JOS S≤2 R≥8; OFL S≤1, R≥4; ERY S≤1, R≥4; TET S≤4, R≥8; CIP S≤1, R≥2; AZI S≤0.12, R≥4; CLA S≤1, R≥4; PRI R≥2.

∗ P <0.05.

Abbreviations: MH, Mycoplasma hominis; UU, Ureaplasma urealyticum; UP, Ureaplasma parvum; DOT, Doxycycline; JOS, Josamycin; OFL, Ofloxacin; ERY, Erythromycin; TET, Tetracycline; CIP, Ciprofloxacin; AZI, Azithromycin; CLA, Clarithromycin; PRI, Pristamycin; S, Susceptible; I, Intermediate; R, Resistant.

Table 4.
Antimicrobial susceptibility patterns of each microorganism according to the type of specimens
Species Urine Endocervical swab
DOT JOS OFL ERY TET CIP AZI CLA PRI DOT JOS OFL ERY TET CIP AZI CLA PRI
MH S (%) 100.0 100.0 50.0 0.0 100.0 50.0 25.0 0.0 100.0 100.0 95.0 55.0 0.0 100.0 20.0 0.0 0.0 100.0
I (%) 0.0 0.0 25.0 0.0 0.0 25.0 25.0 25.0 0.0 0.0 0.0 15.0 5.0 0.0 35.0 20.0 5.0 –
R (%) 0.0 0.0 25.0 100.0 0.0 25.0 50.0 75.0 0.0 0.0 5.0 30.0 95.0 0.0 45.0 80.0 95.0 0.0
UU S (%) 100.0 100.0 56.3 93.8 100.0 12.5 93.8 93.8 100.0 83.3 100.0 0.0 66.7 83.3 0.0 50.0 83.3 100.0
I (%) 0.0 0.0 43.8 0.0 0.0 25.0 0.0 0.0 0.0 0.0 0.0 66.7 33.3 0.0 16.7 33.3 16.7 –
R (%) 0.0 0.0 0.0 6.3 0.0 62.5 6.3 6.3 0.0 16.7 0.0 33.3 0.0 16.7 83.3 16.7 0.0 0.0
UP S (%) 94.9 100.0 61.5 94.9 89.7 28.2 97.4 87.2 100.0 100.0 100.0 57.1 67.9 100.0 10.7 76.8 80.4 100.0
I (%) 2.6 0.0 30.8 2.6 5.1 51.3 2.6 12.8 0.0 0.0 0.0 26.8 12.5 0.0 50.0 5.4 0.0 –
R (%) 2.6 0.0 7.7 2.6 5.1 20.5 0.0 0.0 0.0 0.0 0.0 16.1 19.6 0.0 39.3 17.9 19.6 0.0
Ureaplasma spp. S (%) 96.6 100.0 59.3 94.9 93.2 22.0 96.6 88.1 100.0 98.6 100.0 48.6 63.9 98.6 8.3 70.8 77.8 100.0
I (%) 1.7 0.0 35.6 1.7 3.4 42.4 1.7 10.2 0.0 0.0 0.0 34.7 15.3 0.0 40.3 9.7 1.4 –
R (%) 1.7 0.0 5.1 3.4 3.4 35.6 1.7 1.7 0.0 1.4 0.0 16.7 20.8 1.4 51.4 19.4 20.8 0.0

The breakpoints (mg/L) are as follows: DOT S≤4, R≥8; JOS S≤2 R≥8; OFL S≤1, R≥4; ERY S≤1, R≥4; TET S≤4, R≥8; CIP S≤1, R≥2; AZI S≤0.12, R≥4; CLA S≤1, R≥4; PRI R≥2. Abbreviations: MH, Mycoplasma hominis; UU, Ureaplasma urealyticum; UP, Ureaplasma parvum; DOT, Doxycycline; JOS, Josamycin; OFL, Ofloxacin; ERY, Erythromycin; TET, Tetracycline; CIP, Ciprofloxacin; AZI, Azithromycin; CLA, Clarithromycin; PRI, Pristamycin; S, Susceptible; I, Intermediate; R, Resistant.

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