{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T18:51:44Z","timestamp":1788202304714,"version":"build-2803163510"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T00:00:00Z","timestamp":1588809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"DOI":"10.1371\/journal.pone.0232777","type":"journal-article","created":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T17:38:42Z","timestamp":1588873122000},"page":"e0232777","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["emm Types and clusters and macrolide resistance of pediatric group A streptococcal isolates in Central Greece during 2011-2017"],"prefix":"10.1371","volume":"15","author":[{"given":"Ioanna N.","family":"Grivea","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2390-3603","authenticated-orcid":true,"given":"George A.","family":"Syrogiannopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aspasia N.","family":"Michoula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Gazeti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ergina","family":"Malli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Tsilipounidaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sotirios","family":"Fouzas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Anthracopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efthymia","family":"Petinaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,5,7]]},"reference":[{"key":"pone.0232777.ref001","first-page":"19","volume-title":"Streptococcal infections: clinical aspects, microbiology, and molecular pathogenesis","author":"DL Stevens","year":"2000"},{"key":"pone.0232777.ref002","doi-asserted-by":"crossref","first-page":"307","DOI":"10.4049\/jimmunol.89.3.307","article-title":"Current knowledge of type-specific M antigens of group A streptococci","volume":"89","author":"RC Lancefield","year":"1962","journal-title":"J Immunol"},{"key":"pone.0232777.ref003","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1038\/292457a0","article-title":"Type-specific protective immunity evoked by synthetic peptide of Streptococcus pyogenes M protein","volume":"292","author":"EH Beachey","year":"1981","journal-title":"Nature"},{"key":"pone.0232777.ref004","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1084\/jem.161.3.623","article-title":"Location of variable and conserved epitopes among the multiple serotypes of streptococcal M protein","volume":"161","author":"KF Jones","year":"1985","journal-title":"J Exp Med"},{"key":"pone.0232777.ref005","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1084\/jem.163.5.1191","article-title":"Localization of protective epitopes of the amino terminus of type 5 streptococcal M protein","volume":"163","author":"JB Dale","year":"1986","journal-title":"J Exp Med"},{"key":"pone.0232777.ref006","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1128\/JCM.34.4.953-958.1996","article-title":"Sequencing emm-specific PCR products for routine and accurate typing of group A streptococci","volume":"34","author":"B Beall","year":"1996","journal-title":"J Clin Microbiol"},{"key":"pone.0232777.ref007","doi-asserted-by":"crossref","first-page":"E222","DOI":"10.1111\/1469-0691.12134","article-title":"Updated model of group A Streptococcus M proteins based on a comprehensive worldwide study","volume":"19","author":"DJ McMillan","year":"2013","journal-title":"Clin Microbiol Infect"},{"key":"pone.0232777.ref008","doi-asserted-by":"crossref","first-page":"8175","DOI":"10.1016\/j.vaccine.2011.09.005","article-title":"New 30-valent M protein-based vaccine evokes cross-opsonic antibodies against non-vaccine serotypes of group A streptococci","volume":"29","author":"JB Dale","year":"2011","journal-title":"Vaccine"},{"key":"pone.0232777.ref009","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1016\/j.vaccine.2013.01.019","article-title":"Potential coverage of a multivalent M protein-based group A streptococcal vaccine","volume":"31","author":"JB Dale","year":"2013","journal-title":"Vaccine"},{"key":"pone.0232777.ref010","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1093\/infdis\/jiu260","article-title":"A systematic and functional classification of Streptococcus pyogenes that serves as a new tool for molecular typing and vaccine development","volume":"210","author":"M Sanderson-Smith","year":"2014","journal-title":"J Infect Dis"},{"key":"pone.0232777.ref011","doi-asserted-by":"crossref","first-page":"e84","DOI":"10.1093\/cid\/ciu490","article-title":"The emm-cluster typing system for Group A Streptococcus identifies epidemiologic similarities across the Pacific region","volume":"59","author":"G Baroux","year":"2014","journal-title":"Clin Infect Dis"},{"key":"pone.0232777.ref012","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1093\/cid\/ciu649","article-title":"Added value of the emm-cluster typing system to analyze group A Streptococcus epidemiology in high-income settings","volume":"59","author":"ST Shulman","year":"2014","journal-title":"Clin Infect Dis"},{"key":"pone.0232777.ref013","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1128\/AAC.40.8.1817","article-title":"Streptococcus pneumoniae and Streptococcus pyogenes resistant to macrolides but sensitive to clindamycin: a common resistance pattern mediated by an efflux system","volume":"40","author":"J Sutcliffe","year":"1996","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0232777.ref014","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1046\/j.1365-2958.1996.01521.x","article-title":"Molecular cloning and functional analysis of a novel macrolide-resistance determinant, mefA, from Streptococcus pyogenes","volume":"22","author":"J Clancy","year":"1996","journal-title":"Mol Microbiol"},{"key":"pone.0232777.ref015","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1128\/AAC.39.3.577","article-title":"Erythromycin resistance by ribosome modification","volume":"39","author":"B Weisblum","year":"1995","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0232777.ref016","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1128\/AAC.42.2.257","article-title":"A novel erythromycin resistance methylase gene (ermTR) in Streptococcus pyogenes","volume":"42","author":"H Sepp\u00e4l\u00e4","year":"1998","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0232777.ref017","doi-asserted-by":"crossref","first-page":"2823","DOI":"10.1128\/AAC.43.12.2823","article-title":"Nomenclature for macrolide and macrolide-lincosamide-streptogramin B resistance determinants","volume":"43","author":"MC Roberts","year":"1999","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0232777.ref018","doi-asserted-by":"crossref","first-page":"3559","DOI":"10.1128\/AAC.48.9.3559-3562.2004","article-title":"Emergence of macrolide-rresistant Streptococcus pyogenes strains in French children","volume":"48","author":"E Bingen","year":"2004","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0232777.ref019","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1093\/jac\/dkh420","article-title":"A rapid increase in macrolide resistance in Streptococcus pyogenes isolated in Poland during 1996\u20132002","volume":"54","author":"K Szczypa","year":"2004","journal-title":"J Antimicrob Chemother"},{"key":"pone.0232777.ref020","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1128\/AAC.49.5.2109-2111.2005","article-title":"Rapid inversion of the prevalences of macrolide resistance phenotypes paralleled by a diversification of T and emm types among Streptococcus pyogenes in Portugal","volume":"49","author":"the Portuguese Surveillance Group for the Study of Respiratory Pathogens","year":"2005","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0232777.ref021","doi-asserted-by":"crossref","first-page":"939","DOI":"10.3201\/eid1106.041247","article-title":"Macrolide- and telithromycin-resistant Streptococcus pyogenes, Belgium, 1999\u20132003","volume":"11","author":"S Malhotra-Kumar","year":"2005","journal-title":"Emerg Infect Dis"},{"key":"pone.0232777.ref022","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.ijantimicag.2006.07.023","article-title":"Macrolide resistance rates in respiratory pathogens in Slovenia following reduced macrolide use","volume":"28","author":"M \u010ci\u017eman","year":"2006","journal-title":"Int J Antimicrob Agents"},{"key":"pone.0232777.ref023","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1179\/joc.2007.19.5.500","article-title":"Susceptibilities of Streptococcus pyogenes and Streptococcus pneumoniae to macrolides and telithromycin: data from an Italian multicenter study","volume":"19","author":"A Mazzariol","year":"2007","journal-title":"J Chemother"},{"key":"pone.0232777.ref024","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1186\/1471-2180-12-215","article-title":"Molecular epidemiology, antimicrobial susceptibilities and resistance mechanisms of Streptococcus pyogenes isolates resistant to erythromycin and tetracycline in Spain (1994\u20132006)","volume":"12","author":"V Rubio-L\u00f3pez","year":"2012","journal-title":"BMC Microbiol"},{"key":"pone.0232777.ref025","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.ijmm.2012.09.001","article-title":"Decline in macrolide-resistant Streptococcus pyogenes isolates from French children","volume":"302","author":"C d\u2019Humi\u00e8res","year":"2012","journal-title":"Int J Med Microbiol"},{"key":"pone.0232777.ref026","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1093\/jac\/dku039","article-title":"What causes decreased erythromycin resistance in Streptococcus pyogenes? Dynamics of four clones in a southern European region from 2005 to 2012","volume":"69","author":"M Montes","year":"2014","journal-title":"J Antimicrob Chemother"},{"key":"pone.0232777.ref027","doi-asserted-by":"crossref","first-page":"2729","DOI":"10.1093\/jac\/dkv182","article-title":"Declining macrolide resistance in Streptococcus pyogenes in Portugal (2007\u201313) was accompanied by continuous clonal changes","volume":"70","author":"the Portuguese Group for the Study of Streptococcal Infections","year":"2015","journal-title":"J Antimicrob Chemother"},{"key":"pone.0232777.ref028","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1099\/jmm.0.000146","article-title":"Evolution of macrolide resistance in Streptococcus pyogenes over 14 years in an area of central Italy","volume":"64","author":"R Olivieri","year":"2015","journal-title":"J Med Microbiol"},{"key":"pone.0232777.ref029","doi-asserted-by":"crossref","first-page":"e71558","DOI":"10.1371\/journal.pone.0071558","article-title":"Seven-year surveillance of emm types of pediatric group A streptococcal pharyngitis isolates in western Greece","volume":"8","author":"GA Syrogiannopoulos","year":"2013","journal-title":"PLoS One"},{"key":"pone.0232777.ref030","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1093\/jac\/dkw116","article-title":"Molecular analysis of Streptococcus pyogenes macrolide resistance of paediatric isolates during a 7 year period (2007\u201313).","volume":"71","author":"A Michos","year":"2016","journal-title":"J Antimicrob Chemother"},{"key":"pone.0232777.ref031","doi-asserted-by":"crossref","first-page":"2562","DOI":"10.1128\/AAC.40.11.2562","article-title":"Detection of erythromycin-resistant determinants by PCR","volume":"40","author":"J Sutcliffe","year":"1996","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0232777.ref032","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1128\/AAC.43.9.2144","article-title":"Prevalence and mechanisms of macrolide resistance in clinical isolates of group A streptococci from Ontario, Canada","volume":"43","author":"JCS De Azevedo","year":"1999","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0232777.ref033","doi-asserted-by":"crossref","first-page":"e00622","DOI":"10.1128\/mBio.00622-15","article-title":"Emergence of a new highly successful acapsular group A Streptococcus clade of genotype emm89 in the United Kingdom","volume":"6","author":"CE Turner","year":"2015","journal-title":"mBio"},{"key":"pone.0232777.ref034","doi-asserted-by":"crossref","first-page":"2416","DOI":"10.1128\/IAI.69.4.2416-2427.2001","article-title":"Multilocus sequence typing of Streptococcus pyogenes and the relationships between emm type and clone","volume":"69","author":"MC Enright","year":"2001","journal-title":"Infect Immun"},{"key":"pone.0232777.ref035","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.3201\/eid1809.120049","article-title":"Antimicrobial drug use and macrolide-resistant Streptococcus pyogenes, Belgium","volume":"18","author":"L Van Heirstraeten","year":"2012","journal-title":"Emerg Infect Dis"},{"key":"pone.0232777.ref036","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1080\/00220973.1995.9943797","article-title":"Multiple regression approach to analyzing contingency tables: post hoc and planned comparison procedures","volume":"64","author":"TM Beasley","year":"1995","journal-title":"J Exp Educ"},{"key":"pone.0232777.ref037","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/S0924-8579(02)00253-4","article-title":"Clinical isolates of macrolide-resistant Streptococcus pyogenes in Central Greece","volume":"21","author":"E Petinaki","year":"2003","journal-title":"Int J Antimicrob Agents"},{"key":"pone.0232777.ref038","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.ijantimicag.2010.01.025","article-title":"Macrolide-resistant Streptococcus pyogenes in Central Greece: prevalence; mechanism and molecular identification","volume":"35","author":"E Malli","year":"2010","journal-title":"Int J Antimicrob Agents"},{"key":"pone.0232777.ref039","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1128\/JCM.02089-15","article-title":"Epidemiology analysis of Streptococcus pyogenes in a hospital in southern Taiwan by use of the updated emm cluster typing system","volume":"54","author":"C Chiang-Ni","year":"2016","journal-title":"J Clin Microbiol"},{"key":"pone.0232777.ref040","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1086\/503422","article-title":"High diversity of group A streptococcal emm types among healthy schoolchildren in Ethiopia","volume":"42","author":"A Abdissa","year":"2006","journal-title":"Clin Infect Dis"},{"key":"pone.0232777.ref041","doi-asserted-by":"crossref","first-page":"e01780","DOI":"10.1128\/mBio.01780-15","article-title":"Emergence of the same successful clade among distinct populations of emm89 Streptococcus pyogenes in multiple geographic regions","volume":"6","author":"A Fri\u00e3es","year":"2015","journal-title":"mBio"},{"key":"pone.0232777.ref042","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1128\/JCM.00301-15","article-title":"Streptococcus pyogenes emm types and clusters during a 7-year period (2007 to 2013) in pharyngeal and nonpharyngeal pediatric isolates","volume":"53","author":"F Koutouzi","year":"2015","journal-title":"J Clin Microbiol"},{"key":"pone.0232777.ref043","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1128\/AAC.48.4.1369-1373.2004","article-title":"Clonal relatedness of erythromycin-resistant Streptococcus pyogenes isolates in Germany","volume":"48","author":"RR Reinert","year":"2004","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0232777.ref044","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1111\/j.1469-0691.2006.01408.x","article-title":"Identification of macrolide-resistant clones of Streptococcus pyogenes in Portugal","volume":"12","author":"C Silva-Costa","year":"2006","journal-title":"Clin Microbiol Infect"},{"key":"pone.0232777.ref045","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1111\/j.1469-0691.2008.02104.x","article-title":"Melo-Cristino J; the Portuguese Surveillance Group for the Study of Respiratory Pathogens. Decrease in macrolide resistance and clonal instability among Streptococcus pyogenes in Portugal","volume":"14","author":"C Silva-Costa","year":"2008","journal-title":"Clin Microbiol Infect"},{"key":"pone.0232777.ref046","doi-asserted-by":"crossref","first-page":"1896","DOI":"10.1128\/AAC.50.5.1896-1899.2006","article-title":"Macrolide-resistant Streptococcus pyogenes in Norway: population structure and resistance determinants","volume":"50","author":"P Littauer","year":"2006","journal-title":"Antimicrob Agents Chemother"},{"issue":"Suppl 6","key":"pone.0232777.ref047","first-page":"vi37","article-title":"European Surveillance of Antimicrobial Consumption (ESAC): outpatient macrolide, lincosamide and streptogramin (MLS) use in Europe (1997\u20132009)","volume":"66","author":"N Adriaenssens","year":"2011","journal-title":"J Antimicrob Chemother"},{"key":"pone.0232777.ref048","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.jinf.2013.08.013","article-title":"Streptococcus pyogenes emm-types in northern Spain; population dynamics over a 7-year period","volume":"68","author":"E Tamayo","year":"2014","journal-title":"J Infect"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0232777","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T20:27:02Z","timestamp":1696105622000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0232777"}},"subtitle":[],"editor":[{"given":"Jose","family":"Melo-Cristino","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,5,7]]},"references-count":48,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0232777","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,7]]}}}