Clonal Spread of Group A Streptococcus with the New Type of Erythromycin Resistance

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In 1990, a new type of erythromycin resistance phenotype, designated NR, was found in group A streptococcus (GAS) in Finland. In the present study, the distribution of GAS isolates with this and other erythromycin-resistance phenotypes was surveyed in Finland, and the clonality of the isolates was explored. Of 4179 GAS isolates collected from all over Finland, 695 (17%) were resistant to erythromycin, and 82% of these had the NR phenotype. Of a group of 96 isolates with the NR phenotype from different areas, 91% was T4 serotype, opacity factor-positive. The majority of these isolates were studied further: All were M4 serotype and 88% were of one clonal origin in genetic analyses. Thus, one single clone predominates among erythromycin-resistant GAS in Finland. This clone is of T4M4 serotype and mediates the new type of erythromycin resistance, characterized by the NR phenotype.

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