{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:02:45Z","timestamp":1790301765888,"version":"4.1.0"},"reference-count":45,"publisher":"American Society for Microbiology","issue":"9","license":[{"start":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T00:00:00Z","timestamp":1663632000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/doi.org\/10.1128\/AuthorWarrantyLicense.v1"},{"start":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T00:00:00Z","timestamp":1663632000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100000030","name":"HHS | Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2022,9,20]]},"abstract":"<jats:p>\n            All known group A streptococci [GAS] are susceptible to \u03b2-lactam antibiotics.  We recently identified an invasive GAS (iGAS) variant (\n            <jats:italic>emm43.4<\/jats:italic>\n            \/PBP2x-T553K) with unusually high minimum inhibitory concentrations (MICs) for ampicillin and amoxicillin, although clinically susceptible to \u03b2-lactams. We aimed to quantitate PBP2x variants, small changes in \u03b2-lactam MICs, and lineages within contemporary population-based iGAS. PBP2x substitutions were comprehensively identified among 13,727 iGAS recovered during 2015-2021, in the USA. Isolates were subjected to antimicrobial susceptibility testing employing low range agar diffusion and PBP2x variants were subjected to phylogenetic analyses. Fifty-five variants were defined based upon substitutions within an assigned PBP2x transpeptidase domain. Twenty-nine of these variants, representing 338\/13,727 (2.5%) isolates and 16\n            <jats:italic>emm<\/jats:italic>\n            types, exhibited slightly elevated \u03b2-lactam MICs, none of which were above clinical breakpoints.\n          <\/jats:p>","DOI":"10.1128\/aac.00802-22","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T13:01:25Z","timestamp":1660568485000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":36,"title":["Invasive Group A Streptococcal Penicillin Binding Protein 2\u00d7 Variants Associated with Reduced Susceptibility to \u03b2-Lactam Antibiotics in the United States, 2015\u20132021"],"prefix":"10.1128","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8222-7353","authenticated-orcid":true,"given":"Sopio","family":"Chochua","sequence":"first","affiliation":[{"name":"Respiratory Disease Branch, National Center for Immunizations and 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