Tetracycline resistance mediated by tet(M) has variable integrative conjugative element composition in mycoplasma hominis strains isolated in the United Kingdom from 2005 to 2015

Victoria Chalker, Martin G. Sharratt, Christopher L. Rees, Oliver H. Bell, Edward Portal, Kirsty Sands, Matthew S. Payne, Lucy C. Jones, Owen B. Spiller*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


A minimal genome and absent bacterial cell wall render Mycoplasma hominis inherently resistant to most antimicrobials except lincosamides, tetracyclines, and fluoroquinolones. Often dismissed as a commensal (except where linked to preterm birth), it causes septic arthritis in immunodeficient patients and is increasingly associated with transplant failure (particularly lung) accompanying immunosuppression. We examined antimicrobial susceptibility (AST) on strains archived from 2005 to 2015 submitted to the Public Health England reference laboratory and determined the underlying mechanism of resistance by whole-genome sequencing (WGS). Archived M. hominis strains included 32/115 from invasive infection (sepsis, cerebrospinal [CSF], peritoneal, and pleural fluid) over the 10-year period (6.4% of all samples submitted from 2010 to 2015 were positive). No clindamycin resistance was detected, while two strains were resistant to moxifloxacin and levofloxacin (resistance mutations S83L or E87G in gyrA and S81I or E84V in parC). One of these strains and 11 additional strains were tetracycline resistant, mediated by tet(M) carried within an integrative conjugative element (ICE) consistently integrated at the somatic rumA gene; however, the ICEs varied widely in 5 to 19 associated accessory genes. WGS analysis showed that tet(M)-carrying strains were not clonal, refuting previous speculation that the ICE was broken and immobile. We found tet(M)- positive and -negative strains (including the multiresistant 2015 strain) to be equally susceptible to tigecycline and josamycin; however, the British National Formulary does not include guidance for these. Continued M. hominis investigation and AST surveillance (especially immunocompromised patients) is warranted, and the limited number of therapeutics needs to be expanded in the United Kingdom.

Original languageEnglish
Article numberARTN e02513-20
Number of pages12
JournalAntimicrobial Agents and Chemotherapy
Issue number4
Publication statusPublished - Apr 2021

Bibliographical note

Publisher Copyright:
© 2021 American Society for Microbiology. All rights reserved.

Copyright 2021 Elsevier B.V., All rights reserved.


  • Antibiotic resistance
  • Antimicrobial activity
  • Antimicrobial resistance
  • Epidemiology
  • Genome analysis
  • Genomics
  • Integral conjugative element
  • Mycoplasma
  • Mycoplasma hominis
  • Tetracyclines
  • United Kingdom
  • GYRA
  • PARC
  • epidemiology
  • antimicrobial resistance
  • antibiotic resistance
  • genome analysis
  • genomics
  • antimicrobial activity
  • integral conjugative element
  • GENE
  • tetracyclines


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