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Background  Infections by  Streptococcus gallolyticus subsp. pasteurianus  (SGSP) is often underestimated. Herein, the epidemiological features and resistant characteristics of SGSP in mainland China are characterized to enable a better understanding of its role in clinical infections.    Methods  In the present work, 45 SGSP isolates were collected from the samples of bloodstream, urine, aseptic body fluid, and fetal membrane/placenta from patients in 8 tertiary general hospitals of 6 cities/provinces in China from 2011 to 2017. The identification of all isolates was performed using traditional biochemical methods, 16S rRNA and  gyrB  sequencing, followed by the characterization of their antibiotic resistance profiling and involved genes.    Results  Among 34 non-pregnancy-related patients, 4 (4/34,11.8%) patients had gastrointestinal cancer, 10 (10/34, 29.4%) patients had diabetes, and one patient had infective endocarditis. Moreover, 11 cases of pregnant women were associated with intrauterine infection (9/11, 81.2%) and urinary tract infection (1/11, 9.1%), respectively. Except one, all other SGSP isolates were correctly identified by the BD Phoenix automated system. We found that all SGSP isolates were phenotypically susceptible to penicillin, ampicillin, cefotaxime, meropenem, and vancomycin. Forty strains (40/45, 88.9%) were both erythromycin and clindamycin-resistant, belonging to the cMLS B  phenotype, and the majority of them carried  erm (B) gene (39/40, 97.5%). Although the cMLS B / erm (B) constituted the most frequently identified phenotype/genotype combination (25/40, 62.5%) among all erythromycin-resistant cMLS B  isolates,  erm (B)/ erm (A),  erm (B)/ mef (A/E), and  erm (B)/ erm (T) was detected in 7, 4, and 3 isolates, respectively. Furthermore, 43 strains (43/45, 95.6%) were tetracycline-resistant, and out of these, 39 strains (39/45, 86.7%) carried  tet (L), 27(27/45, 60.0%) strains carried  tet (O), and 7 (7/45, 15.6%) strains carried  tet (M), alone or combined, respectively. All erythromycin-resistant isolates were also resistant to tetracycline.    Conclusions  It is important to study and draw attention on SGSP, an underreported opportunistic pathogen targeting immunodeficient populations, notably elderly subjects, pregnant women and neonates.

Microbiological and clinical characteristics of Streptococcus gallolyticus subsp. pasteurianus infection in China