<i>emm</i>
            Types, Virulence Factors, and Antibiotic Resistance of Invasive
            <i>Streptococcus pyogenes</i>
            Isolates from Italy: What Has Changed in 11 Years?

Creti, Roberta; Imperi, Monica; Baldassarri, Lucilla; Pataracchia, Marco; Recchia, Simona; Alfarone, Giovanna; Orefici, Graziella

doi:10.1128/jcm.00513-07

Cited by 58 publications

(47 citation statements)

References 36 publications

(39 reference statements)

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“…The percentage of overall tetracycline resistance among GAS isolates in this study was 13.6%, which is comparable to what has been reported in other studies (7,12,15,18). However, tetracycline resistance was significantly higher during the early surveillance years (23.6%; 2004 to 2008) than in the later surveillance years (3.7%; 2009 to 2013) (P Ͻ 0.001).…”

Section: Discussionsupporting

confidence: 79%

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Epidemiology of Invasive Group A Streptococcal Disease in Alaska, 2001 to 2013

et al. 2016

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The Arctic Investigations Program (AIP) began surveillance for invasive group A streptococcal (GAS) infections in Alaska in 2000 as part of the invasive bacterial diseases population-based laboratory surveillance program. Between 2001 and 2013, there were 516 cases of GAS infection reported, for an overall annual incidence of 5.8 cases per 100,000 persons with 56 deaths (case fatality rate, 10.7%). Of the 516 confirmed cases of invasive GAS infection, 422 (82%) had isolates available for laboratory analysis. All isolates were susceptible to penicillin, cefotaxime, and levofloxacin. Resistance to tetracycline, erythromycin, and clindamycin was seen in 11% (n ‫؍‬ 8), 5.8% (n ‫؍‬ 20), and 1.2% (n ‫؍‬ 4) of the isolates, respectively. A total of 51 emm types were identified, of which emm1 (11.1%) was the most prevalent, followed by emm82 (8.8%), emm49 (7.8%), emm12 and emm3 (6.6% each), emm89 (6.2%), emm108 (5.5%), emm28 (4.7%), emm92 (4%), and emm41 (3.8%). The five most common emm types accounted for 41% of isolates. The emm types in the proposed 26-valent and 30-valent vaccines accounted for 56% and 78% of all cases, respectively. GAS remains an important cause of invasive bacterial disease in Alaska. Continued surveillance of GAS infections will help improve understanding of the epidemiology of invasive disease, with an impact on disease control, notification of outbreaks, and vaccine development.

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Section: Discussionsupporting

confidence: 79%

“…To date, Ͼ200 different emm types have been reported. In most countries, emm types 1, 3, 12, and 28 have traditionally been associated with invasive GAS disease (9,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

mentioning

confidence: 99%

Epidemiology of Invasive Group A Streptococcal Disease in Alaska, 2001 to 2013

et al. 2016

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“…Although M/ emm type 6 is only responsible for 3-14 % of S. pyogenes infections (Alonso et al, 2005;Pérez-Trallero et al, 2001;Creti et al, 2007), it is the predominant isolate in surveys of fluoroquinolone resistance in S. pyogenes due to a polymorphism in parC (Orscheln et al, 2005). Our data from pediatric isolates of S. pyogenes confirmed this M/emm 6 predominance finding.…”

Section: Discussionsupporting

confidence: 79%

An intrinsic pattern of reduced susceptibility to fluoroquinolones in pediatric isolates of Streptococcus pyogenes

Yan¹,

Schreckenberger

Zheng

et al. 2008

Diagnostic Microbiology and Infectious Disease

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A total of 116 clinical isolates collected in 2003 from a tertiary pediatric hospital and a primary pediatric department in Chicago, Illinois were screened for reduced susceptibility to selected fluoroquinolones by disc diffusion. Correlation between reduced susceptibility and point mutations in the quinolone resistance-determining region of parC and gyrA genes were evaluated, and point mutations were compared with other reports of isolates derived from adult or mixed patient populations. 9% of isolates had reduced susceptibility to one or more of these fluoroquinolones by Etest: ciprofloxacin, levofloxacin, moxifloxacin. A single point mutation (Ser-79) in parC seemed responsible for the reduced susceptibility. Resistant S. pyogenes isolates were compared using M/ emm type, RepPCR, and pulsed-field gel electrophoresis (PFGE). RepPCR provided no more separation of strains than M/emm typing and PFGE results with SgrA1 were more discriminatory than with SmaI. The majority of these isolates were M/emm type 6. PFGE analysis using SgrA1 demonstrated 2 different resistant strains among the M/emm type 6 isolates. The findings suggest that a population of S. pyogenes with an intrinsic reduced susceptibility to fluoroquinolones exists in pediatric clinical isolates. Monitoring of amino acid changes in both parC and gyrA will assist in the prediction of emergence of high level fluoroquinolone resistance.

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“…A close association between the emm genotype and antibiotic resistance has been reported [5,13]. We observed an ERY resistance rate of 4.6%, suggesting that almost all isolates were susceptible and that the ERY-resistant isolates belonged to a few limited emm types, such as emm28 and emm89.…”

Section: Discussionmentioning

confidence: 58%

“…The distribution of emm genotypes during a defined period can be used to understand the dynamic changes in GAS strains in the region. Several reports have been published on the correlation between emm genotypes and antibiotic resistance, but the distributions of antibiotic-resistant emm genotypes vary geographically [13,14]. In general, antibiotic resistance is closely associated with the consumption of drugs.…”

Section: Introductionmentioning

confidence: 99%