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Invasive Streptococcus pyogenes disease in Spain: a microbiological and epidemiological study covering the period 2007–2019

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Abstract

The aim of this study is to present the first nationwide microbiological and epidemiological study of invasive group A Streptococcus (iGAS) disease in Spain. One thousand eight hundred ninety-three iGAS isolates were analyzed over 2007–2019. emm typing was performed by sequencing the gene’s variable 5’ end, exotoxin genes were identified by PCR, and antimicrobial susceptibility explored via the E test and disk diffusion. Five hundred twenty-three isolates were associated with sepsis, 292 with cellulitis, 232 with scarlet fever, 153 with pneumonia, 141 with streptococcal toxic shock syndrome, and 94 with necrotizing fasciitis. The most prevalent emm types were emm1 (449/1893 isolates), emm89 (210/1893), emm3 (208/1893), emm4 (150/1893), emm12 (112/1893) emm6 (107/1893), emm87 (89/1893), emm28 (88/1893), emm75 (78/1893), emm77 (78/1893), emm11 (58/1893), and emm22 (35/1893). emm1, emm3, emm4, and emm6 were the predominant types affecting children (mostly respiratory infections), while emm11, emm77, and emm89 prevailed in the elderly (mostly skin infections). Each emm type was associated with one or more exotoxin gene (spe, sme, and ssa) profiles. speA was detected in 660 isolates, speB in 1829, speC in 1014, speF in 1826, speG in 1651, speJ in 716, speH in 331, smeZ in 720, and ssa in 512. Isolates with speA were associated with the most severe infections. Penicillin susceptibility was universal. Two hundred twenty-four isolates were resistant to tetracycline, 169 to erythromycin, and 81 to clindamycin. Tetracycline, erythromycin, and clindamycin resistance rates declined over the study period. The above information could serve as the basis for continued surveillance efforts designed to control disease cause by this bacterium.

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Acknowledgments

We thank the microbiology laboratories across Spain for their interest and participation in SPIGAS. We also thank Adrian Burton for editing and language assistance (Physical Evidence Scientific Translations; http://physicalevidence.es).

Funding

This work was partially funded by the Instituto de Salud Carlos III (MPY 377/18).

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Authors and Affiliations

  1. Laboratorio de Referencia e Investigación en Taxonomía, Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain

    Pilar Villalón, Juan A. Sáez-Nieto, Virginia Rubio-López, María José Medina-Pascual, Noelia Garrido, Gema Carrasco, Silvia Pino-Rosa & Sylvia Valdezate

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  1. Pilar Villalón
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  2. Juan A. Sáez-Nieto
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  3. Virginia Rubio-López
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Contributions

Villalón P: conception and design of the study, acquisition, analysis and interpretation of data, and drafting the article. Sáez-Nieto JA, Rubio-López V, Medina-Pascual MJ, Garrido N, Carrasco G, and Pino-Rosa S: acquisition, analysis and interpretation of data, and critical review. Valdezate S: conception of the study, analysis and interpretation of data, critical review of the article. All authors read and approved the final manuscript.

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Correspondence to Pilar Villalón.

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Villalón, P., Sáez-Nieto, J.A., Rubio-López, V. et al. Invasive Streptococcus pyogenes disease in Spain: a microbiological and epidemiological study covering the period 2007–2019. Eur J Clin Microbiol Infect Dis 40, 2295–2303 (2021). https://doi.org/10.1007/s10096-021-04279-2

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