{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T03:10:54Z","timestamp":1789787454949,"version":"4.0.1"},"reference-count":35,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T00:00:00Z","timestamp":1711411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T00:00:00Z","timestamp":1711411200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100023961","name":"Centro de Investigaci\u00f3n Biotecnol\u00f3gica en Red de Enfermedades Infecciosas","doi-asserted-by":"crossref","award":["CIBERINFEC AES 2022"],"award-info":[{"award-number":["CIBERINFEC AES 2022"]}],"id":[{"id":"10.13039\/501100023961","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["mSphere"],"published-print":{"date-parts":[[2024,3,26]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>\n              In December 2022, an alert was published in the UK and other European countries reporting an unusual increase in the incidence of\n              <jats:italic>Streptococcus pyogenes<\/jats:italic>\n              infections. Our aim was to describe the clinical, microbiological, and molecular characteristics of group A\n              <jats:italic>Streptococcus<\/jats:italic>\n              invasive infections (iGAS) in children prospectively recruited in Spain (September 2022\u2013March 2023), and compare invasive strains with strains causing mild infections. One hundred thirty isolates of\n              <jats:italic>S. pyogenes<\/jats:italic>\n              causing infection (102 iGAS and 28 mild infections) were included in the microbiological study:\n              <jats:italic>emm<\/jats:italic>\n              typing, antimicrobial susceptibility testing, and sequencing for core genome multilocus sequence typing (cgMLST), resistome, and virulome analysis. Clinical data were available from 93 cases and 21 controls. Pneumonia was the most frequent clinical syndrome (41\/93; 44.1%), followed by deep tissue abscesses (23\/93; 24.7%), and osteoarticular infections (11\/93; 11.8%). Forty-six of 93 cases (49.5%) required admission to the pediatric intensive care unit. iGAS isolates mainly belonged to\n              <jats:italic>emm<\/jats:italic>\n              1 and\n              <jats:italic>emm<\/jats:italic>\n              12;\n              <jats:italic>emm<\/jats:italic>\n              12 predominated in 2022 but was surpassed by\n              <jats:italic>emm<\/jats:italic>\n              1 in 2023. Spread of M1\n              <jats:sub>UK<\/jats:sub>\n              sublineage (28\/64 M1 isolates) was communicated for the first time in Spain, but it did not replace the still predominant sublineage M1\n              <jats:sub>global<\/jats:sub>\n              (36\/64). Furthermore, a difference in\n              <jats:italic>emm<\/jats:italic>\n              types compared with the mild cases was observed with predominance of\n              <jats:italic>emm<\/jats:italic>\n              1, but also important representativeness of\n              <jats:italic>emm<\/jats:italic>\n              12 and\n              <jats:italic>emm<\/jats:italic>\n              89 isolates. Pneumonia, the most frequent and severe iGAS diagnosed, was associated with the\n              <jats:italic>spe<\/jats:italic>\n              A gene, while the\n              <jats:italic>ssa<\/jats:italic>\n              superantigen was associated with milder cases. iGAS isolates were mainly susceptible to antimicrobials. cgMLST showed five major clusters: ST28-ST1357\/\n              <jats:italic>emm<\/jats:italic>\n              1, ST36-ST425\/\n              <jats:italic>emm<\/jats:italic>\n              12, ST242\/\n              <jats:italic>emm<\/jats:italic>\n              12.37, ST39\/\n              <jats:italic>emm<\/jats:italic>\n              4, and ST101-ST1295\/\n              <jats:italic>emm<\/jats:italic>\n              89 isolates.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>IMPORTANCE<\/jats:title>\n            <jats:p>\n              Group A\n              <jats:italic>Streptococcus<\/jats:italic>\n              (GAS) is a common bacterial pathogen in the pediatric population. In the last months of 2022, an unusual increase in GAS infections was detected in various countries. Certain strains were overrepresented, although the cause of this raise is not clear. In Spain, a significant increase in mild and severe cases was also observed; this study evaluates the clinical characteristics and the strains involved in both scenarios. Our study showed that the increase in incidence did not correlate with an increase in resistance or with an\n              <jats:italic>emm<\/jats:italic>\n              types shift. However, there seemed to be a rise in severity, partly related to a greater rate of pneumonia cases. These findings suggest a general increase in iGAS that highlights the need for surveillance. The introduction of whole genome sequencing in the diagnosis and surveillance of iGAS may improve the understanding of antibiotic resistance, virulence, and clones, facilitating its control and personalized treatment.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/msphere.00729-23","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T13:27:28Z","timestamp":1709645248000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":49,"title":["Clinical, microbiological, and molecular characterization of pediatric invasive infections by\n            <i>Streptococcus pyogenes<\/i>\n            in Spain in a context of global outbreak"],"prefix":"10.1128","volume":"9","author":[{"given":"Eva","family":"Ram\u00edrez de Arellano","sequence":"first","affiliation":[{"name":"Laboratorio de Referencia e Investigaci\u00f3n en Resistencia a Antibi\u00f3ticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiolog\u00eda, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain"},{"name":"CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Saavedra-Lozano","sequence":"additional","affiliation":[{"name":"CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain"},{"name":"Servicio de Pediatr\u00eda, Hospital General Universitario Gregorio Mara\u00f1\u00f3n. Universidad Complutense, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3026-2178","authenticated-orcid":false,"given":"Pilar","family":"Villal\u00f3n","sequence":"additional","affiliation":[{"name":"Laboratorio de Referencia e Investigaci\u00f3n en Taxonom\u00eda, Centro Nacional de Microbiolog\u00eda, Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Jov\u00e9-Blanco","sequence":"additional","affiliation":[{"name":"Servicio de Pediatr\u00eda, Hospital General Universitario Gregorio Mara\u00f1\u00f3n. Universidad Complutense, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Grandioso","sequence":"additional","affiliation":[{"name":"Servicio de Microbiolog\u00eda, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared","family":"Sotelo","sequence":"additional","affiliation":[{"name":"Laboratorio de Referencia e Investigaci\u00f3n en Resistencia a Antibi\u00f3ticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiolog\u00eda, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain"},{"name":"CIBER de Enfermedades Infecciosas (CIBERINFEC). 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Instituto Salud Carlos III, Madrid, Spain"},{"name":"Servicio de Microbiolog\u00eda, Hospital San Cecilio, Instituto de Investigaci\u00f3n IbS.GRANADA, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Cercenado","sequence":"additional","affiliation":[{"name":"Servicio de Microbiolog\u00eda Cl\u00ednica y Enfermedades Infecciosas, Hospital Universitario Gregorio Mara\u00f1\u00f3n, Madrid, Spain"},{"name":"CIBER de Enfermedades Respiratorias (CIBERES). Instituto Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Mellado","sequence":"additional","affiliation":[{"name":"Servicio de Pediatr\u00eda y Enfermedades Infecciosas, Hospital Universitario La Paz, Fundaci\u00f3n IdiPaz Madrid, Spain. 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