Association of group A streptococcal emm types with virulence traits and macrolide-resistance genes is independent of the source of isolation

Streptococcus pyogenes (group A streptococci; GAS) recovered from paediatric pharyngitis (101 isolates) and asymptomatic children (79 isolates) in the same geographical area and period, as well as isolates collected during an enhanced national surveillance programme for GAS invasive diseases (79 isolates), were screened for the incidence of the streptococcal pyrogenic exotoxin (spe) genes speA and speC, as well as the macrolide-resistance genes erm(B), erm(A) subclass erm(TR) and mef(A), and typed by emm sequencing. The speA gene was detected with comparable incidence among throat isolates (13.9% of asymptomatic children and 16.8% of pharyngitis isolates) and in 25% of invasive cases; in contrast, speC incidence was, surprisingly, higher in paediatric populations (55.4%in pharyngitis isolates and 65.8%in asymptomatic children) than in invasive isolates (30 %; P , 0.0001). Macrolide resistance was detected in 26.6, 38.0 and 37.6% of strains belonging to invasive, asymptomatic and pharyngitis populations, respectively. The different incidences of exotoxin and antibiotic-resistance genes among populations did not appear to have an intrinsic clinical significance, but may reflect the propensity of these traits to be associated with certain emm types independent of the source from which the strains were isolated. Further investigations with larger emm-type populations are warranted to confirm this.