Macrolide resistance and emm type distribution of invasive pediatric group A streptococcal isolates: Three-year prospective surveillance from a children's hospital

OBJECTIVE: Macrolide-resistant group A streptococci (GAS) have been suggested to have more invasive potential. An M protein-based GAS vaccine is currently in development. We sought to define the GAS emm types and macrolide resistance rates among pediatric invasive GAS isolates collected prospectively during a recent 40-month period at our children's hospital. PATIENTS AND METHODS: We prospectively identified and collected GAS isolates from patients with invasive GAS disease (isolates from normally sterile sites). Susceptibility assays for erythromycin and clindamycin were performed by E-test. emm typing was performed by the Centers for Disease Control and Prevention. Clinical characteristics of patients were identified by chart review. RESULTS: A total of 37 patient isolates were identified, of which 35 isolates were able to be characterized. Four patients had underlying illness. No macrolide resistance was detected among the isolates. The most common emm types causing invasive disease were emm 1.0 (43%) and emm 12.0 (11.1%). CONCLUSIONS: In this group of 35 invasive GAS isolates, no cases of macrolide resistance were found. emm type 1 accounted for the highest percentage of invasive disease, followed by emm type 12. The type-specific GAS M protein-based vaccine currently in development includes the emm types of 33 of 35 (94%) of the invasive emm types in this series.