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Molecular emm genotyping and antibiotic susceptibility of Streptococcus dysgalactiae subsp. equisimilis isolated from invasive and noninvasive infections

¹ Dept. of Clin. Microbiol., Saitama Inst. of Public Health, Saitama PR, Japan;

² Kitasato Institute for Life Sciences, Kitasato University, Tokyo, Japan;

³ Laboratory Medicine, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan;

⁴ Department of Bacteriological Examination, Nihon University Itabashi Hospital, Tokyo, Japan;

⁵ Div. of Infection Control, Dept. of Med. Safety Admin., Dokkyo Univ. Sch. of Med. Hosp., Tochigi PR,

⁶ E-mail: ubukatak{at}lisci.kitasato-u.ac.jp

Received May 29, 2009
Accepted September 3, 2009

To analyze characteristics of infections caused by Streptococcus dysgalactiae subsp. equisimilis, clinical isolates (n=145) were collected at 11 medical institutions between September 2003 and October 2005. These isolates belonged to Lancefield group A (n=5), group C (n=18), or group G (n=122). Among all isolates, 42 strains were isolated from sterile samples such as blood, synovial fluid, and tissue specimens from patients, - mostly over 50 years with invasive infections -, and included 7 cases of streptococcal toxic shock syndrome and necrotizing fasciitis. In contrast, the remaining 103 were mainly isolated from patients of all age groups with noninvasive infections such as pharyngotonsillitis. These isolates were classified into 25 types based on emm genotyping. A significant difference in emm types was observed between isolates from invasive and noninvasive infections (P <0.001); stG485, stG6792, and stG2078 predominated among isolates from invasive infections. A phylogenic tree of complete open reading frames of emm genes in this organism showed high homology with those of Streptococcus pyogenes, but not with those of other streptococci. The presence of 5 different clones was estimated based on from DNA profiles of isolates from invasive infections obtained by PFGE. Genes for resistance to macrolides [erm(A), 3 isolates; erm(B), 5; mef(A), 7] and levofloxacin (mutations in gyrA and parC, 4) were identified in this organism. These results suggest the need for further nationwide surveillance of invasive infections caused by S. dysgalactiae subsp. equisimilis.