{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T13:08:53Z","timestamp":1754399333910},"reference-count":48,"publisher":"Akademiai Kiado Zrt.","issue":"1","content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMicr"],"published-print":{"date-parts":[[2019,12,13]]},"abstract":"Group A streptococcus (GAS) is a human pathogen causing a broad range of infections, linked with global morbidity and mortality. Macrolide resistance rates vary significantly in different parts of the world. Driving factors of the emergence and spread of resistant clones are not clearly understood. We investigated 102 macrolide-resistant GAS strains collected during the period 2014\u20132018 from various clinical specimens from Bulgarian patients. Strains were characterized by the presence of mefA\/mefE, ermA<\/jats:italic>, and ermB<\/jats:italic> using polymerase chain reaction and sequencing for mefA\/mefE<\/jats:italic>. Resistant strains were studied by emm<\/jats:italic> sequence typing and emm<\/jats:italic>-cluster system. Most prevalent emm<\/jats:italic> types among the macrolide-resistant GAS strains were emm<\/jats:italic>28 (22.55%), emm<\/jats:italic>12 (17.65%), and emm<\/jats:italic>4 (16.66%). Almost all (87.25%) of the macrolide-resistant isolates harboring ermB<\/jats:italic> were emm<\/jats:italic>28. The isolates that carried ermA<\/jats:italic> were predominantly emm<\/jats:italic>12 (38.24%) and emm<\/jats:italic>77 (38.24%), with fewer emm<\/jats:italic>89 (23.53%). The isolates harbored predominantly mefE (49 isolates)<\/jats:italic> and only 9 strains carried mefA<\/jats:italic>. The most prevalent emm<\/jats:italic> clusters among the GAS isolates were E4 (40.20%), A-C4 (17.65%), and E1 (16.66%). The study\u2019s results suggest that dissemination of specific clones in GAS population may also be the reason for the increasing macrolide-resistance rate in our country.<\/jats:p>","DOI":"10.1556\/030.66.2019.033","type":"journal-article","created":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T12:57:52Z","timestamp":1576241872000},"page":"14-17","update-policy":"http:\/\/dx.doi.org\/10.1556\/policypage.crossmark.crossref.1","source":"Crossref","is-referenced-by-count":8,"title":["Molecular emm typing of Bulgarian macrolide-resistant Streptococcus pyogenes isolates"],"prefix":"10.1556","volume":"67","author":[{"given":"Adile","family":"Muhtarova","sequence":"first","affiliation":[{"name":"1 Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalina","family":"Mihova","sequence":"additional","affiliation":[{"name":"2 Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Faculty of Medicine, Medical University, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rumyana","family":"Markovska","sequence":"additional","affiliation":[{"name":"1 Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Mitov","sequence":"additional","affiliation":[{"name":"1 Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radka","family":"Kaneva","sequence":"additional","affiliation":[{"name":"2 Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Faculty of Medicine, Medical University, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raina","family":"Gergova","sequence":"additional","affiliation":[{"name":"1 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