{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T23:48:09Z","timestamp":1785887289619,"version":"3.56.0"},"reference-count":42,"publisher":"American Society for Microbiology","issue":"11","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["2020.08493.BD"],"award-info":[{"award-number":["2020.08493.BD"]}],"id":[{"id":"10.13039\/501100001871","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":[[2025,11,5]]},"abstract":"ABSTRACT<\/jats:title>\n \n \n \n Increases in macrolide resistance occurred recently among\n Streptococcus pyogenes<\/jats:italic>\n (Group A\n Streptococcus<\/jats:italic>\n , GAS) in some countries. While the importance of monitoring the clinical and molecular epidemiology of non-invasive GAS is increasingly recognized, most surveillance focuses on invasive infections, since culture is rarely performed in tonsillo-pharyngitis. We determined the antimicrobial susceptibility and characterized the macrolide-resistant lineages of 2,002 pharyngeal isolates recovered in a Portuguese hospital in 2014\u20132019. There were seasonal variations in the numbers of recovered isolates, with peaks shifting between March\u2013July and October\u2013December, but consistently low numbers in August and September. Macrolide-resistant and macrolide-susceptible GAS presented independent seasonal and clonal dynamics, with resistant isolates showing lower genetic diversity and minimal overlap with susceptible lineages. Overall, 84 (4%), 77 (4%), and 52 (3%) isolates were resistant to erythromycin, clindamycin, and tetracycline, respectively. Until 2018, macrolide resistance was mainly due to an internationally disseminated\n emm<\/jats:italic>\n 77-ST63 lineage carrying\n erm<\/jats:italic>\n (A) and\n tet<\/jats:italic>\n (O) in ICE\n Sp2905<\/jats:italic>\n and an\n emm<\/jats:italic>\n 75-ST49 lineage carrying\n mef<\/jats:italic>\n (A)-\n msr<\/jats:italic>\n (D) in a novel \u02781207.3 variant. In 2019, resistance peaked at 9% due to the rapid expansion of\n mef<\/jats:italic>\n (A)-\n msr<\/jats:italic>\n (D)-positive\n emm<\/jats:italic>\n 2-ST55 isolates, replacing previous lineages. Other minor resistant lineages carried mostly\n erm<\/jats:italic>\n (B) in a diversity of mobile genetic elements, including\n emm<\/jats:italic>\n 75-ST150,\n emm<\/jats:italic>\n 9-ST75,\n emm<\/jats:italic>\n 11-ST403,\n emm<\/jats:italic>\n 12-ST36,\n emm<\/jats:italic>\n 76-ST50, and\n emm<\/jats:italic>\n 77-ST399 [\n erm<\/jats:italic>\n (T)]. Tetracycline resistance was associated with the genes\n tet<\/jats:italic>\n (M) and\n tet<\/jats:italic>\n (O), in most cases co-located in the same genetic elements as the\n erm<\/jats:italic>\n genes. This study reveals clonal changes among macrolide-resistant GAS driving fluctuations in macrolide resistance and associated phenotypes.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1128\/aac.00968-25","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:21:16Z","timestamp":1760106076000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":1,"title":["Increase of macrolide resistance among\n Streptococcus pyogenes<\/i>\n pharyngitis driven by a\n mef<\/i>\n (A)-\n msr<\/i>\n (D)\/\n emm<\/i>\n 2-ST55 lineage in Portugal (2014\u20132019)"],"prefix":"10.1128","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7567-2405","authenticated-orcid":true,"given":"Ana","family":"Fri\u00e3es","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01c27hj86","id-type":"ROR","asserted-by":"publisher"}],"name":"Instituto de Microbiologia, Faculdade de Medicina,Universidade de Lisboa","place":["Lisbon, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8691-0771","authenticated-orcid":true,"given":"Rafael","family":"Mamede","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01c27hj86","id-type":"ROR","asserted-by":"publisher"}],"name":"Instituto de Microbiologia, Faculdade de Medicina,Universidade de Lisboa","place":["Lisbon, Portugal"]},{"id":[{"id":"https:\/\/ror.org\/0346k0491","id-type":"ROR","asserted-by":"publisher"}],"name":"Gulbenkian Institute for Molecular Medicine","place":["Lisbon, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Santos","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01c27hj86","id-type":"ROR","asserted-by":"publisher"}],"name":"Instituto de Microbiologia, Faculdade de Medicina,Universidade de Lisboa","place":["Lisbon, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Marr\u00e3o","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Patologia Cl\u00ednica, Laborat\u00f3rio de Microbiologia, Unidade Local de Sa\u00fade da Regi\u00e3o de Leiria","place":["Leiria, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8643-1722","authenticated-orcid":true,"given":"Jos\u00e9","family":"Melo-Cristino","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01c27hj86","id-type":"ROR","asserted-by":"publisher"}],"name":"Instituto de Microbiologia, Faculdade de Medicina,Universidade de Lisboa","place":["Lisbon, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4084-6233","authenticated-orcid":true,"given":"Mario","family":"Ramirez","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01c27hj86","id-type":"ROR","asserted-by":"publisher"}],"name":"Instituto de Microbiologia, Faculdade de Medicina,Universidade de Lisboa","place":["Lisbon, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1586\/14787210.2015.1023292"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms10122316"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac468"},{"key":"e_1_3_5_5_2","unstructured":"World Health Organization. 2024. 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