Multicenter Study of Molecular Epidemiology and Antibiotic Resistance of Group A Streptococci in 2008-2009 in Korea

Abstract

Background: Group A Streptococcus (GAS) is responsible for a wide spectrum of human diseases. We investigated the distribution of emm types and antibiotic resistance rates of GAS from clinical specimens in several Korean medical centers. Methods: A total of 192 strains of GAS from throat, blood, and other specimens collected in Seoul, Busan, Ulsan, Iksan, and Jeju were studied in 2008-2009. The emm genotypes were identified using PCR and sequencing. Antimicrobial susceptibility testing was performed by disk diffusion. Phenotypes of macrolide resistance were evaluated, and macrolide resistance genes were determined by PCR. Results: The emm89 (33.9%) was most frequently detected, followed by emm1 (12.5%), emm12 (8.3%), emm4 (7.8%), and emm75 (7.3%). The distribution of emm types did not show a close relation to the type of specimen and was rather different for each area. The resistance rates to erythromycin (ERY) and clindamycin (CLI) were 4.6% and 3.7%, respectively. Among the 9 ERY-resistant strains, the rate of constitutive resistance was 88.9%, compared with 11.1% for the M phenotype. Five of the ERY-resistant strains were emm28. Conclusion: This multicenter study reveals heterogenous emm genotypes by geographic area. Rates of resistance to ERY and CLI were low, and most of the ERY-resistant strains showed a constitutive macrolide- lincosamide-streptogramin B (cMLSB) phenotype.