Prevalence and Risk Factors for Antimicrobial Resistance of Mycoplasma genitalium Infections in a High-Risk Population

<b>Background/Objectives:</b><i>Mycoplasma genitalium</i> (<i>MG</i>) infections and antibiotic resistance are increasing in prevalence while treatment options are limited. Limited data exist regarding <i>MG</i> resistance in Israel. Our aim was to study the prevalence of <i>MG</i> resistance in a sexually transmitted infection (STI) clinic in Israel. <b>Methods:</b> We performed a single-center retrospective study among patients attending an STI clinic during 2019-2020. <i>MG</i> isolates were tested to detect their resistance to azithromycin and fluoroquinolones (FQs) using commercial kits (Allplex™ <i>MG</i> & AziR Assay, Allplex™ <i>MG</i> & MoxiR Assay). We collected patient data regarding the risk factors for STIs and resistance. A multivariate logistic regression model was used to identify the risk factors for resistance. <b>Results:</b> Of the 142 patients who tested positive for <i>MG</i>, 50 (35.2%) and 22 (15.5%) had resistant mutations to azithromycin and FQ, respectively, and 13 (9.2%) showed resistance to both agents. In a multivariate logistic regression model, men who have sex with men (RR 7.01 95% CI 3.00-16.33) and past STIs (RR 2.33 95% CI 1.01-5.34) were independent risk factors for azithromycin resistance. <b>Conclusions:</b> We found a high prevalence of azithromycin resistance and, to a lesser degree, FQ resistance. These findings may help design the treatment guidelines and support routine resistance testing in high-risk populations.