Highlights
- •Men who have sex with men using HIV pre-exposure prophylaxis often use antibiotics.
- •Oropharynx often colonised with antibiotic-resistant commensal Neisseria species.
- •Shotgun metagenomic sequencing shows high abundance of antibiotic-resistance genes.
- •Fluoroquinolones, macrolides, tetracyclines, and multidrug efflux pumps involved.
- •Stewardship should reduce antibiotic consumption in populations at risk for STI.
Summary
Background
Phenotypic studies have found high levels of antimicrobial resistance to cephalosporins,
macrolides and fluoroquinolones in commensal Neisseria species in the oropharynx of men who have sex with men (MSM) using HIV pre-exposure
prophylaxis (PrEP). These species include Neisseria subflava and Neisseria mucosa. This may represent a risk to pathogens like Neisseria gonorrhoeae which tend to take up antibiotic resistance genes (ARGs) from other bacteria. We
aimed to explore to what extent the oropharyngeal resistome of MSM using PrEP differed
from the general population.
Methods
We collected oropharyngeal swabs from 32 individuals of the general population and
from 64 MSM using PrEP. Thirty-two MSM had consumed antibiotics in the previous six
months, whereas none of the other participants had. Samples underwent shotgun metagenomic
sequencing. Sequencing reads were mapped against MEGARes 2.0 to estimate ARG abundance.
ARG abundance was compared between groups by zero-inflated negative binomial regression.
Findings
ARG abundance was significantly lower in the general population than in MSM (ratio
0.41, 95% CI 0.26–0.65). More specifically, this was the case for fluoroquinolones
(0.33, 95% CI 0.15–0.69), macrolides (0.37, 95% CI 0.25–0.56), tetracyclines (0.41,
95% CI 0.25–0.69), and multidrug efflux pumps (0.11, 95% CI 0.03–0.33), but not for
beta-lactams (1.38, 95% CI 0.73–2.61). There were no significant differences in ARG
abundance between MSM who had used antibiotics and those that had not.
Interpretation
The resistome of MSM using PrEP is enriched with ARGs, independent of recent antibiotic
use. Stewardship campaigns should aim to reduce antibiotic consumption in populations
at high risk for STIs.
Keywords
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Article info
Publication history
Published online: February 08, 2023
Accepted:
February 4,
2023
Identification
Copyright
© 2023 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
