Logo of eidLink to Publisher's site
Emerg Infect Dis. 1999 Mar-Apr; 5(2): 235–240.
PMCID: PMC2640710

Clonal differences among erythromycin-resistant Streptococcus pyogenes in Spain.


The aim of this study was to determine whether the high levels of erythromycin resistance in Streptococcus pyogenes found in Spain are due to the introduction and spread of one or more clones. Phenotypic and genotypic techniques were used to characterize all erythromycin-resistant S. pyogenes (ErR) isolated in Gipuzkoa, Spain, in the last 10 years and 128 ErR isolated in Vitoria and Madrid during 1996. Of 437 ErR, 97% had the M phenotype; all 283 of the strains studied had the mefA determinant of resistance. After biotyping, T serotyping, emm typing, and genotyping, four major clones were detected. Clones B (biotype I, type T4, emm4, pulsed-field gel electrophoresis [PFGE] II) and D (biotype V, type T8.25, emm75, PFGE IV) comprised 78.8% of all ErR. The resistance of S. pyogenes to erythromycin was mainly due to an efflux mechanism of resistance (M phenotype); few clones were responsible for it.

Full Text

The Full Text of this article is available as a PDF (107K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Holmström L, Nyman B, Rosengren M, Wallander S, Ripa T. Outbreaks of infections with erythromycin-resistant group A streptococci in child day care centres. Scand J Infect Dis. 1990;22(2):179–185. [PubMed]
  • Leclercq R, Courvalin P. Bacterial resistance to macrolide, lincosamide, and streptogramin antibiotics by target modification. Antimicrob Agents Chemother. 1991 Jul;35(7):1267–1272. [PMC free article] [PubMed]
  • Seppälä H, Skurnik M, Soini H, Roberts MC, Huovinen P. A novel erythromycin resistance methylase gene (ermTR) in Streptococcus pyogenes. Antimicrob Agents Chemother. 1998 Feb;42(2):257–262. [PMC free article] [PubMed]
  • Sutcliffe J, Tait-Kamradt A, Wondrack L. Streptococcus pneumoniae and Streptococcus pyogenes resistant to macrolides but sensitive to clindamycin: a common resistance pattern mediated by an efflux system. Antimicrob Agents Chemother. 1996 Aug;40(8):1817–1824. [PMC free article] [PubMed]
  • Clancy J, Petitpas J, Dib-Hajj F, Yuan W, Cronan M, Kamath AV, Bergeron J, Retsema JA. Molecular cloning and functional analysis of a novel macrolide-resistance determinant, mefA, from Streptococcus pyogenes. Mol Microbiol. 1996 Dec;22(5):867–879. [PubMed]
  • Garcia-Bermejo I, Cacho J, Orden B, Alós JI, Gómez-Garcés JL. Emergence of erythromycin-resistant, clindamycin-susceptible Streptococcus pyogenes isolates in Madrid, Spain. Antimicrob Agents Chemother. 1998 Apr;42(4):989–990. [PMC free article] [PubMed]
  • Orden B, Perez-Trallero E, Montes M, Martínez R. Erythromycin resistance of Streptococcus pyogenes in Madrid. Pediatr Infect Dis J. 1998 Jun;17(6):470–473. [PubMed]
  • Perez-Trallero E, Urbieta M, Montes M, Ayestaran I, Marimon JM. Emergence of Streptococcus pyogenes strains resistant to erythromycin in Gipuzkoa, Spain. Eur J Clin Microbiol Infect Dis. 1998 Jan;17(1):25–31. [PubMed]
  • Bouvet A, Geslin P, Kriz-Kuzemenska P, Blanc V, Devine C, Grimont F. Restricted association between biotypes and serotypes within group A streptococci. J Clin Microbiol. 1994 May;32(5):1312–1317. [PMC free article] [PubMed]
  • Saunders NA, Hallas G, Gaworzewska ET, Metherell L, Efstratiou A, Hookey JV, George RC. PCR-enzyme-linked immunosorbent assay and sequencing as an alternative to serology for M-antigen typing of Streptococcus pyogenes. J Clin Microbiol. 1997 Oct;35(10):2689–2691. [PMC free article] [PubMed]
  • Single LA, Martin DR. Clonal differences within M-types of the group A Streptococcus revealed by pulsed field gel electrophoresis. FEMS Microbiol Lett. 1992 Feb 1;70(1):85–89. [PubMed]
  • Kataja J, Huovinen P, Muotiala A, Vuopio-Varkila J, Efstratiou A, Hallas G, Seppälä H. Clonal spread of group A streptococcus with the new type of erythromycin resistance. Finnish Study Group for Antimicrobial Resistance. J Infect Dis. 1998 Mar;177(3):786–789. [PubMed]
  • Jasir A, Schalén C. Survey of macrolide resistance phenotypes in Swedish clinical isolates of Streptococcus pyogenes. J Antimicrob Chemother. 1998 Jan;41(1):135–137. [PubMed]
  • Kriebernegg I, Feierl G, Grisold A, Marth E. In-vitro susceptibility of group A beta-haemolytic streptococci (GABHS) to penicillin, erythromycin, clarithromycin and azithromycin in Styria, Austria. Zentralbl Bakteriol. 1998 Jan;287(1-2):33–39. [PubMed]
  • Cornaglia G, Ligozzi M, Mazzariol A, Valentini M, Orefici G, Fontana R. Rapid increase of resistance to erythromycin and clindamycin in Streptococcus pyogenes in Italy, 1993-1995. The Italian Surveillance Group for Antimicrobial Resistance. Emerg Infect Dis. 1996 Oct-Dec;2(4):339–342. [PMC free article] [PubMed]
  • Cocuzza C, Blandino G, Mattina R, Nicoletti F, Nicoletti G. Antibiotic susceptibility of group A streptococci in 2 Italian cities: Milano and Catania. Microb Drug Resist. 1997 Winter;3(4):379–384. [PubMed]
  • Borzani M, De Luca M, Varotto F. A survey of susceptibility to erythromycin amongst Streptococcus pyogenes isolates in Italy. J Antimicrob Chemother. 1997 Sep;40(3):457–458. [PubMed]
  • Haase AM, Melder A, Mathews JD, Kemp DJ, Adams M. Clonal diversity of Streptococcus pyogenes within some M-types revealed by multilocus enzyme electrophoresis. Epidemiol Infect. 1994 Dec;113(3):455–462. [PMC free article] [PubMed]
  • Scott RJ, Naidoo J, Lightfoot NF, George RC. A community outbreak of group A beta haemolytic streptococci with transferable resistance to erythromycin. Epidemiol Infect. 1989 Feb;102(1):85–91. [PMC free article] [PubMed]

Articles from Emerging Infectious Diseases are provided here courtesy of Centers for Disease Control and Prevention


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Compound
    PubChem chemical compound records that cite the current articles. These references are taken from those provided on submitted PubChem chemical substance records. Multiple substance records may contribute to the PubChem compound record.
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles
  • Substance
    PubChem chemical substance records that cite the current articles. These references are taken from those provided on submitted PubChem chemical substance records.
  • Taxonomy
    Taxonomy records associated with the current articles through taxonomic information on related molecular database records (Nucleotide, Protein, Gene, SNP, Structure).
  • Taxonomy Tree
    Taxonomy Tree

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...