BACKGROUND Ureaplasma spp. have been implicated in a variety of clinical conditions and certain serovars are likely to be disease-associated. Hence, the ascending trend of Ureaplasma spp. resistance to antimicrobials should deserve more attention. Here we assessed the extent of antimicrobial resistance of Ureaplasma serovars in Tunisia, and investigated the underlying molecular basis. METHODS This study included 101 molecularly typed Ureaplasma spp. clinical strains isolated over a 12-year time period (2005-2017). The antimicrobial susceptibility was tested against nine antibacterial agents using the broth microdilution method. Neighbor-joining tree was constructed to establish the phylogenetic relationships among isolates. RESULTS We found that all ureaplasma isolates were resistant to ciprofloxacin and erythromycin, intermediately resistant to azithromycin, and susceptible to doxycycline, moxifloxacin and josamycin. Ofloxacin and levofloxacin resistance was found in 73.27 and 17.82%, respectively, while 37.62% of isolates proved resistant to tetracycline. Consequently, we detected an elevated multidrug resistance rate among ureaplasma isolates (37.62%), particularly among serovars 2, 5, 8, and 9 (77.77% overall), as well as serovars 4, 10, 12, and 13 (52.63% overall). In most cases, drug resistance was found to be associated with known molecular mechanisms, yet we have identified two novel mutations in the L22 protein, which might be associated with macrolide-resistance. CONCLUSION To our knowledge, this is the first study that reports the widespread expansion of multidrug resistance among Ureaplasma serovars, a finding of importance in terms of both surveillance and antimicrobial usage.

中文翻译：

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多药耐药性在突尼西亚血清型中的传播。

背景技术脲原体。已被证实与多种临床疾病有关，某些血清型可能与疾病有关。因此，脲原体的上升趋势。对抗菌素的耐药性应引起更多重视。在这里，我们评估了突尼斯地区的Ureaplasma serovars的抗药性程度，并研究了潜在的分子基础。方法本研究包括101种分子型尿素原种。在12年期间（2005-2017）分离的临床菌株。使用肉汤微稀释法测试了对九种抗菌剂的抗菌敏感性。构造相邻树以建立分离株之间的系统发育关系。结果我们发现所有分离的脲原体均对环丙沙星和红霉素具有抗药性，对阿奇霉素中等耐药，对强力霉素，莫西沙星和若沙霉素敏感。氧氟沙星和左氧氟沙星的耐药率分别为73.27％和17.82％，而分离株的37.62％被证明对四环素具有耐药性。因此，我们在脲原体分离株中发现了多药耐药率（37.62％），特别是血清型2、5、8和9（总体为77.77％）以及血清型4、10、12和13（总体为52.63％） ）。在大多数情况下，发现耐药性与已知的分子机制有关，但我们已经在L22蛋白中鉴定出两个新突变，这可能与大环内酯类药物耐药有关。结论据我们所知，这是第一项报道尿毒症血清型中多药耐药性广泛扩展的研究，