Rafei Rayane, Al Iaali Rayane, Osman Marwan, Dabboussi Fouad, Hamze Monzer
Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
Infect Genet Evol. 2022 Apr;99:105258. doi: 10.1016/j.meegid.2022.105258. Epub 2022 Feb 24.
Watchful epidemiological surveillance of macrolide-resistant Group A Streptococcus (MRGAS) clones is important owing to the evolutionary and epidemiological dynamic of GAS. Meanwhile, data on the global distribution of MRGAS emm types according to macrolide resistance phenotypes and genotypes are scant and need to be updated. For this, the present systematic review analyses a global set of extensively characterized MRGAS isolates from patients of diverse ages and clinical presentations over approximately two decades (2000 to 2020) and recaps the peculiar epidemiological features of the dominant MRGAS clones. Based on the inclusion and exclusion criteria, 53 articles (3593 macrolide-resistant and 15,951 susceptible isolates) distributed over 23 countries were dissected with a predominance of high-income countries over low-income ones. Although macrolide resistance in GAS is highly variable in different countries, its within-GAS distribution seems not to be random. emm pattern E, 13 major emm types (emm12, 4, 28, 77, 75, 11, 22, 92, 58, 60, 94, 63, 114) and 4 emm clusters (A-C4, E1, E6, and E2) were significantly associated with macrolide resistance. emm patterns A-C and D, 14 major emm types (emm89, 3, 6, 2, 44, 82, 87, 118, 5, 49, 81, 59, 227, 78) and 3 well-defined emm clusters (A-C5, E3, and D4) were significantly associated with macrolide susceptibility. Scrutinizing the tendency of each MRGAS emm type to be significantly associated with specific macrolide resistance phenotype or genotype, interesting vignettes are also unveiled. The 30-valent vaccine covers ~95% of MRGAS isolates. The presented data urge the importance of comprehensive nationwide sustained surveillance of MRGAS circulating clones particularly in Low and Middle income countries where sampling bias is high and GAS epidemiology is obfuscated and needs to be demystified.
鉴于A群链球菌（GAS）的进化和流行病学动态，对大环内酯类耐药A群链球菌（MRGAS）克隆进行密切的流行病学监测很重要。与此同时，关于MRGAS emm型根据大环内酯类耐药表型和基因型的全球分布数据很少，需要更新。为此，本系统综述分析了大约二十年间（2000年至2020年）来自不同年龄和临床表现患者的一组全球范围内广泛特征化的MRGAS分离株，并概括了主要MRGAS克隆的独特流行病学特征。根据纳入和排除标准，对分布在23个国家的53篇文章（3593株大环内酯类耐药和15951株敏感分离株）进行了剖析，其中高收入国家的文章占主导地位，低收入国家的文章较少。尽管GAS中的大环内酯类耐药性在不同国家差异很大，但其在GAS内的分布似乎并非随机。emm模式E、13种主要emm型（emm12、4、28、77、75、11、22、92、58、60、94、63、114）和4个emm簇（A-C4、E1、E6和E2）与大环内酯类耐药性显著相关。emm模式A-C和D、14种主要emm型（emm89、3、6、2、44、82、87、118、5、49、81、59、227、78）和3个明确的emm簇（A-C5、E3和D4）与大环内酯类敏感性显著相关。仔细研究每种MRGAS emm型与特定大环内酯类耐药表型或基因型显著相关的趋势，也揭示了一些有趣的情况。30价疫苗覆盖约95%的MRGAS分离株。所呈现的数据凸显了在全国范围内对MRGAS流行克隆进行全面持续监测的重要性，特别是在低收入和中等收入国家，那里抽样偏差很大，GAS流行病学模糊不清，需要揭开其神秘面纱。
