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Fay K, Onukwube J, Chochua S, et al. Patterns of Antibiotic Nonsusceptibility Among Invasive Group A Streptococcus Infections-United States, 2006-2017. Clin Infect Dis. 2021;73(11):1957-1964doi: 10.1093/cid/ciab575.
Fay, K., Onukwube, J., Chochua, S., Schaffner, W., Cieslak, P., Lynfield, R., Muse, A., Smelser, C., Harrison, L. H., Farley, M., Petit, S., Alden, N., Apostal, M., Snippes Vagnone, P., Nanduri, S., Beall, B., & Van Beneden, C. A. (2021). Patterns of Antibiotic Nonsusceptibility Among Invasive Group A Streptococcus Infections-United States, 2006-2017. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 73(11), 1957-1964. https://doi.org/10.1093/cid/ciab575
Fay, Katherine, et al. "Patterns of Antibiotic Nonsusceptibility Among Invasive Group A Streptococcus Infections-United States, 2006-2017." Clinical infectious diseases : an official publication of the Infectious Diseases Society of America vol. 73,11 (2021): 1957-1964. doi: https://doi.org/10.1093/cid/ciab575
Fay K, Onukwube J, Chochua S, Schaffner W, Cieslak P, Lynfield R, Muse A, Smelser C, Harrison LH, Farley M, Petit S, Alden N, Apostal M, Snippes Vagnone P, Nanduri S, Beall B, Van Beneden CA. Patterns of Antibiotic Nonsusceptibility Among Invasive Group A Streptococcus Infections-United States, 2006-2017. Clin Infect Dis. 2021 Dec 06;73(11):1957-1964. doi: 10.1093/cid/ciab575. PMID: 34170310.
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Clin Infect Dis. 2021 Dec 06;73(11):1957-1964. doi: 10.1093/cid/ciab575.

Patterns of Antibiotic Nonsusceptibility Among Invasive Group A Streptococcus Infections-United States, 2006-2017.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Katherine Fay, Jennifer Onukwube, Sopio Chochua, William Schaffner, Paul Cieslak, Ruth Lynfield, Alison Muse, Chad Smelser, Lee H Harrison, Monica Farley, Susan Petit, Nisha Alden, Mirasol Apostal, Paula Snippes Vagnone, Srinivas Nanduri, Bernard Beall, Chris A Van Beneden

Affiliations

  1. Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  2. Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
  3. Public Health Division, Oregon Health Authority, Portland, Oregon, USA.
  4. Minnesota Department of Health, St Paul, Minnesota, USA.
  5. Emerging Infections Program, New York State Department of Health, Rochester, New York, USA.
  6. New Mexico Department of Health, Santa Fe, New Mexico, USA.
  7. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  8. Emerging Infections Program, Emory University, Atlanta, Georgia, USA.
  9. Connecticut Department of Public Health, Hartford, Connecticut, USA.
  10. Colorado Department of Public Health and Environment, Denver, Colorado, USA.
  11. Emerging Infections Program, Oakland, California, USA.

PMID: 34170310 DOI: 10.1093/cid/ciab575

Abstract

BACKGROUND: Treatment of severe group A Streptococcus (GAS) infections requires timely and appropriate antibiotic therapy. We describe the epidemiology of antimicrobial-resistant invasive GAS (iGAS) infections in the United States (US).

METHODS: We analyzed population-based iGAS surveillance data at 10 US sites from 2006 through 2017. Cases were defined as infection with GAS isolated from normally sterile sites or wounds in patients with necrotizing fasciitis or streptococcal toxic shock syndrome. GAS isolates were emm typed. Antimicrobial susceptibility was determined using broth microdilution or whole genome sequencing. We compared characteristics among patients infected with erythromycin-nonsusceptible (EryNS) and clindamycin-nonsusceptible (CliNS) strains to those with susceptible infections. We analyzed proportions of EryNS and CliNS among isolates by site, year, risk factors, and emm type.

RESULTS: Overall, 17 179 iGAS cases were reported; 14.5% were EryNS. Among isolates tested for both inducible and constitutive CliNS (2011-2017), 14.6% were CliNS. Most (99.8%) CliNS isolates were EryNS. Resistance was highest in 2017 (EryNS: 22.8%; CliNS: 22.0%). All isolates were susceptible to β-lactams. EryNS and CliNS infections were most frequent among persons aged 18-34 years and in persons residing in long-term care facilities, experiencing homelessness, incarcerated, or who injected drugs. Patterns varied by site. Patients with nonsusceptible infections were significantly less likely to die. The emm types with >30% EryNS or CliNS included types 77, 58, 11, 83, and 92.

CONCLUSIONS: Increasing prevalence of EryNS and CliNS iGAS infections in the US is predominantly due to expansion of several emm types. Clinicians should consider local resistance patterns when treating iGAS infections.

Published by Oxford University Press for the Infectious Diseases Society of America 2021.

Keywords: antibiotics; epidemiology; group A Streptococcus; invasive disease; resistance

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