Group A streptococci from invasive-disease episodes in Poland are remarkably divergent at the molecular level

Forty-one clinical isolates of group A streptococcus (GAS) were recovered in Poland from patients with severe invasive infections and were analyzed by phenotypic and genotypic techniques. All isolates were characterized by determining their susceptibilities to antimicrobial agents and by determining their types by pulsed-field gel electrophoresis, multilocus sequence typing, emm typing, and the detection of five streptococcal pyrogenic exotoxin genes (speA, speB, speC, speF, ssa). The isolates studied were fully susceptible to penicillin G, levofloxacin, quinupristin-dalfopristin, and linezolid. Resistance to tetracycline, chloramphenicol, and erythromycin was detected in 46.3, 12.1, and 9.8% of the isolates, respectively. A total of 23 different emm sequence types were identified, of which emm1 and emm12 (19.5% each) were the most common, followed by emm81, emm44/61, and emm85. All the emm1 isolates had the speA2 allele. Twenty-three unrelated sequence types (STs) were identified, with the most frequent STs, ST28 and ST36, corresponding to emm1 and emm12, respectively. Six newly found STs (STs 375, 376, 377, 378, 379, and 385) corresponded to emm types 74, 102, 77, 76, 84 and 63, respectively. The emm1 type and the presence of speA2 gene were associated with the severity of GAS infections. This work presents the first molecular study on Polish invasive GAS isolates.