{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:12:26Z","timestamp":1788261146980,"version":"build-2803163510"},"reference-count":29,"publisher":"Microbiology Society","issue":"11","license":[{"start":{"date-parts":[[2019,11,1]],"date-time":"2019-11-01T00:00:00Z","timestamp":1572566400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:p>Despite universal susceptibility to \u03b2-lactams, resistance to second-line antimicrobials (e.g. erythromycin) is increasingly common among group A <jats:italic>\n                     <jats:named-content content-type=\"genus\">\n                        <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/doi.org\/10.1601\/nm.5605\" xlink:type=\"simple\">Streptococcus<\/jats:ext-link>\n                     <\/jats:named-content>\n                  <\/jats:italic> (GAS). To better understand the frequency of regional GAS antimicrobial resistance, we screened a previously described GAS strain collection from Houston, TX, USA, for resistance to commonly used antimicrobials. A total of 100\/929 (10.8\u200a%) showed resistance to at least one antimicrobial. Tetracycline resistance was identified in 52 (5.6 %) GAS strains. The cumulative frequency of erythromycin and clindamycin resistance [macrolide (M) and macrolide-lincosamide-streptogramin (MLS) phenotypes] was greatest among invasive GAS strains (9.9\u200a%) compared to that of strains derived from any other infection type (5.9\u200a%, <jats:italic>P<\/jats:italic>=0.045). We identified <jats:italic>emm<\/jats:italic> types 11, 75, 77 and 92 as the only <jats:italic>emm<\/jats:italic> types with high (e.g. &gt;50\u200a%) within-<jats:italic>emm<\/jats:italic> type resistance and contributing to the majority (24\/26; 92\u200a%) of erythromycin\/clindamycin resistance in invasive GAS. High-frequency resistance <jats:italic>emm<\/jats:italic> types were also significantly overrepresented in invasive GAS strains as indicated by invasive index. We performed whole-genome sequencing to define genetic elements associated with resistance among <jats:italic>emm<\/jats:italic> types 11, 75, 77 and 92. Diverse mobile elements contributed to GAS resistance including transposons, integrative conjugative elements, prophage and a plasmid. Phylogenetic analysis suggests recent clonal emergence of <jats:italic>emm92<\/jats:italic> GAS strains. Our findings indicate that less frequently encountered GAS <jats:italic>emm<\/jats:italic> types disproportionately contribute to resistance phenotypes, are defined by diverse mobile genetic elements and may favour invasive disease.<\/jats:p>","DOI":"10.1099\/mgen.0.000316","type":"journal-article","created":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T17:12:21Z","timestamp":1574442741000},"source":"Crossref","is-referenced-by-count":23,"title":["Unexpected relationships between frequency of antimicrobial resistance, disease phenotype and emm type in group A Streptococcus"],"prefix":"10.1099","volume":"5","author":[{"given":"Misu A.","family":"Sanson","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga R.","family":"Macias","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany J.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2949-7818","authenticated-orcid":false,"given":"Blake","family":"Hanson","sequence":"additional","affiliation":[{"name":"Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Sciences Center at Houston, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Alberto","family":"Vega","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain","family":"Alamarat","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6402-4269","authenticated-orcid":false,"given":"Anthony R.","family":"Flores","sequence":"additional","affiliation":[{"name":"Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Sciences Center at Houston, Houston, TX, USA"},{"name":"Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"345","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw248"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-2648"},{"key":"R3","volume-title":"Red 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