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Background  Group A  Streptococcus  (GAS) causes human diseases ranging in severity from uncomplicated pharyngitis to life-threatening necrotizing fasciitis and shows high rates of macrolide resistance in several countries. Our goal is to identify antimicrobial resistance in Spanish GAS isolates collected between 1994 and 2006 and to determine the molecular epidemiology ( emm /T typing and PFGE) and resistance mechanisms of those resistant to erythromycin and tetracycline.    Results  Two hundred ninety-five out of 898 isolates (32.8%) were erythromycin resistant, with the predominance of  emm 4T4,  emm 75T25, and  emm 28T28, accounting the 67.1% of the 21  emm /T types. Spread of  emm 4T4,  emm 75T25 and  emm 28T28 resistant clones caused high rates of macrolide resistance. The distribution of the phenotypes was M (76.9%), cMLS B  (20.3%), iMLS B  (2.7%) with the involvement of the erythromycin resistance genes  mef (A) (89.5%),  msr (D) (81.7%),  erm (B) (37.3%) and  erm (A) (35.9%).  Sixty-one isolates were tetracycline resistant, with the main representation of the  emm 77T28 among 20  emm /T types. To note, the combination of  tet (M) and  tet (O) tetracycline resistance genes were similar to  tet (M) alone reaching values close to 40%. Resistance to both antibiotics was detected in 19 isolates of 7  emm /T types, being  emm 11T11 and the cMLS B  phenotype the most frequent ones.  erm (B) and  tet (M) were present in almost all the strains, while  erm (A),  mef (A),  msr (D) and  tet (O) appeared in less than half of them.    Conclusions  Spanish GAS were highly resistant to macrolides meanwhile showed minor resistance rate to tetracycline. A remarkable correlation between antimicrobial resistance and  emm /T type was noticed. Clonal spread of  emm 4T4,  emm 75T25 and  emm 28T28 was the main responsable for macrolide resistance where as that  emm 77T28 clones were it to tetraclycline resistance. A wide variety of macrolide resistance genes were responsible for three macrolide resistance phenotypes.

bmc microbiology

Molecular epidemiology, antimicrobial susceptibilities and resistance mechanisms of Streptococcus pyogenes isolates resistant to erythromycin and tetracycline in Spain (1994–2006)