Journal List > Korean J Clin Microbiol > v.14(3) > 1038248

Kim, Koh, Kim, Kang, Kim, Shin, Lee, Jeong, Cho, Chang, and Kim: 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 method. 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 different for each area. The resistance rates to erythromycin (ERY) and clindamycin (CLI) were 4.6% and 3.7%, respectively. Among the nine 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.

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Fig. 1.
Frequency of emm genotypes in this study and study of acute pharyngitis in Jinju, 2009 [14].
kjcm-14-85f1.tif
Table 1.
Distribution of emm genotypes according to specimen type
  Throat Sputum Pus Blood Body fluid Other Total (%)
emm1 9 3 4   5 3 24 (12.5)
emm4 10 1 2   1 1 15 (7.8)
emm6 4 1 3       8 (4.2)
emm9     1       1 (0.5)
emm11 4   4 3 1   12 (6.3)
emm12 9 2 3 1 1   16 (8.3)
emm18     1       1 (0.5)
emm22 1   1       2 (1.0)
emm28 5   1 2 2 1 11 (5.7)
emm44           1 1 (0.5)
emm48     1       1 (0.5)
emm49     1       1 (0.5)
emm50     1       1 (0.5)
emm58       1 1   2 (1.0)
emm63     1       1 (0.5)
emm73   1         1 (0.5)
emm75 8   6       14 (7.3)
emm77     1       1 (0.5)
emm78 2 1         3 (1.6)
emm82 1   1       2 (1.0)
emm85     1       1 (0.5)
emm88 1   1       2 (1.0)
emm89 28 6 23 4   4 65 (33.9)
emm94     1 1     2 (1.0)
emm112 2           2 (1.5)
emm114 1           1 (0.5)
NT 1           1 (0.5)
Total 86 15 58 12 11 10 192

Abbreviation: NT, non-typeable.

Table 2.
Distribution of emm genotypes according to geographic region
  Seoul Guri Busan & Ulsan Iksan & Jeju
emm1 12 (14.5) 6 (13.6) 6 (20.7) 0
emm4 5 (6.0) 6 (13.6) 1 (3.4) 3 (8.3)
emm6 2 (2.4) 1 (2.3) 5 (17.2) 0
emm11 5 (6.0) 3 (6.8) 2 (6.9) 2 (5.6)
emm12 8 (9.6) 2 (4.5) 1 (3.4) 5 (13.9)
emm28 6 (7.2) 2 (4.5) 3 (10.3) 0
emm75 1 (1.2) 7 (15.9) 0 5 (13.9)
emm89 31 (37.3) 14 (31.8) 7 (24.1) 13 (36.1)
Others 13 (15.7) 3 (6.8) 4 (13.8) 8 (22.2)
Total 83 44 29 36
Table 3.
Minimal inhibitory concentrations (MIC) of erythromycin (ERY) and macrolide-resistant determinants among ERY-resistant group A streptococci
No. Location Specimen emm genotype ERY Clindamycin MIC of ERY (μg/mL) Resistant determinant
1 Seoul Pus emm28 R R 256 erm(B)
2 Seoul Blood emm28 R R 256 erm(B)
3 Guri Throat emm4 R S 8 mef(A)
4 Busan Body fluid emm28 R R 256 erm(B)
5 Busan Throat emm28 R R 256 erm(B)
6 Busan Joint fluid emm28 R R 256 erm(B)
7 Iksan Wound emm88 R R 256 erm(B)
8 Jeju Throat emm12 R R 3 erm(B)
9 Jeju Throat NT R R 3 erm(B)

Abbreviations: NT, non-typeable; R, resistant; S, susceptible.

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