{
    "abstract": "Streptococcal toxic shock syndrome (STSS) is a severe invasive infection characterized by the sudden onset of shock, multi-organ failure, and puerperal sepsis and shows high mortality. Its primary cause is group A streptococcus (GAS, Streptococcus pyogenes). In this study, we genotyped the cell-surface M virulence protein gene (emm) from 621 GAS isolates obtained from patients with STSS in Japan in 2013-2018 and performed antimicrobial susceptibility testing using the broth microdilution method. The predominant emm type was found to be 1, followed by 89, 12, and 3, which were identified in more than 70 % of STSS isolates. The proportions of emm3 and emm89 increased from 2.4 % and 12.0 %, respectively, during 2010-2012 to 5.6 % and 23.3 % during 2013-2018. In contrast, the proportion of emm1 decreased from 60.6 % to 39.3 % during the same two periods. Some emm types showed increasing proportions and were not isolated from patients with STSS in 2010-2012. Among these, an emm76 type increased in prevalence and was not included in the 30-valent M protein-based vaccine. Continual investigation of changes in the epidemiology of GAS which causes STSS can provide useful monitoring information such as future vaccination strategies and the emergence status of antimicrobial-resistant bacteria.",
    "authors": [
        {
            "affiliation": "Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan. Electronic address: tdikebe@nih.go.jp.",
            "firstname": "Tadayoshi",
            "initials": "T",
            "lastname": "Ikebe"
        },
        {
            "affiliation": "Department of Microbiology, Tokyo Metropolitan Institute of Public Health, 3-24-1 Hyakunin-cho, Shinjuku-ku, Tokyo 169-0073, Japan.",
            "firstname": "Rumi",
            "initials": "R",
            "lastname": "Okuno"
        },
        {
            "affiliation": "Laboratory of Microbiology, Oita Prefectural Institute of Health and Environment, 2-8 Takae-Nishi, Oita 870-1117, Japan.",
            "firstname": "Yoshiko",
            "initials": "Y",
            "lastname": "Kanda"
        },
        {
            "affiliation": "Laboratory of Microbiology, Oita Prefectural Institute of Health and Environment, 2-8 Takae-Nishi, Oita 870-1117, Japan.",
            "firstname": "Mari",
            "initials": "M",
            "lastname": "Sasaki"
        },
        {
            "affiliation": "Division of Microbiology, Osaka Institute of Public Health, 1-3-69 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan.",
            "firstname": "Takahiro",
            "initials": "T",
            "lastname": "Yamaguchi"
        },
        {
            "affiliation": "Department of Public Health Sciences, Yamaguchi Prefectural Institute of Public Health and Environment, 2-5-67 Aoi, Yamaguchi 753-0821, Japan.",
            "firstname": "Hitoshi",
            "initials": "H",
            "lastname": "Otsuka"
        },
        {
            "affiliation": "Division of Microbiology, Fukushima Prefectural Institute of Public Health, 16-6 Mitouchi, Hokida, Fukushima 960-8560, Japan.",
            "firstname": "Yu",
            "initials": "Y",
            "lastname": "Kazawa"
        },
        {
            "affiliation": "Division of Microbiology, Kanagawa Prefectural Institute of Public Health, 1-3-1 Shimomachiya, Chigasaki, Kanagawa 253-0087, Japan.",
            "firstname": "Miyuki",
            "initials": "M",
            "lastname": "Suzuki"
        },
        {
            "affiliation": "Division of Microbiology, Kanagawa Prefectural Institute of Public Health, 1-3-1 Shimomachiya, Chigasaki, Kanagawa 253-0087, Japan.",
            "firstname": "Hitomi",
            "initials": "H",
            "lastname": "Ohya"
        },
        {
            "affiliation": "Department of Bacteriology, Toyama Institute of Health, 17-1 Naka-Taikouyama, Imizu, Toyama 939-0363, Japan.",
            "firstname": "Kaoru",
            "initials": "K",
            "lastname": "Uchida"
        },
        {
            "affiliation": "Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.",
            "firstname": "Makoto",
            "initials": "M",
            "lastname": "Ohnishi"
        },
        {
            "affiliation": null,
            "firstname": null,
            "initials": null,
            "lastname": null
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2021 The Author(s). Published by Elsevier GmbH.. All rights reserved.",
    "doi": "10.1016/j.ijmm.2021.151496",
    "journal": "International journal of medical microbiology : IJMM",
    "keywords": [
        "Antibiotic resistance",
        "Group A streptococcus",
        "Streptococcal toxic shock syndrome",
        "emm type"
    ],
    "methods": null,
    "publication_date": "2021-03-24",
    "pubmed_id": "33756191",
    "results": null,
    "title": "Molecular characterization and antimicrobial resistance of group A streptococcus isolates in streptococcal toxic shock syndrome cases in Japan from 2013 to 2018.",
    "xml": "<Element 'PubmedArticle' at 0x788502337100>"
}