Abstract

Invasive group A streptococcal (iGAS) infections have been rising in Europe, Australia, and the USA, but few data from China are available. This study was intended to provide local data to mirror the characteristics of iGAS infections in China. Retrospective analysis was performed on the clinical data of the iGAS infections during 2014-2023 in a tertiary hospital in Shanghai, China. Genomic analysis was conducted to characterize the antimicrobial resistance, virulence, prophage, integrative and conjugative elements (ICEs), and phylogenetic clusters. During 2014-2023, a total of 21 iGAS cases were discovered, with soft tissue infections accounting for 61.9% (13/21) and 85.7% (18/21) of isolates resistant to both erythromycin and clindamycin. Three iGAS isolates in 2023 were performed genome sequencing, indicating two were emm12 and one was emm28. Phylogenetic analysis showed that the two emm12 isolates were assigned to Clade II and closely related with Chinese scarlet fever-causing isolates. The emm28 isolate was assigned to the subclades of SC1A and discovered to possess a novel ICE (designated as ICE-SHemm28; Tn916-like), which carried ermB gene and type IV secretion system (T4SS). Emergence of the emm28 iGAS strain harboring a novel macrolide resistance-carrying T4SS-type ICE was identified in invasive infections in Shanghai.

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