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23.06.2018 | Original Investigation

A clone of the emergent Streptococcus pyogenes emm89 clade responsible for a large outbreak in a post-surgery oncology unit in France

Zeitschrift:
Medical Microbiology and Immunology
Autoren:
Céline Plainvert, Magalie Longo, Elise Seringe, Benjamin Saintpierre, Elisabeth Sauvage, Laurence Ma, Johann Beghain, Nicolas Dmytruk, Gislène Collobert, Eric Hernandez, Christian Manuel, Pascal Astagneau, Philippe Glaser, Frédéric Ariey, Claire Poyart, Agnès Fouet
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00430-018-0546-1) contains supplementary material, which is available to authorized users.

Abstract

An outbreak of nosocomial infections due to Streptococcus pyogenes (Group A Streptococcus; GAS) occurred in a post-surgery oncology unit and concerned more than 60 patients and lasted 20 months despite enhanced infection control and prophylaxis measures. All GAS strains were characterized (emm genotype, toxin gene profile and pulse-field gel electrophoresis subtype). Selected strains were sequenced and phylogenetic relationship established. Capacity to form biofilm and interaction with human pulmonary epithelial cells and macrophages were determined. Twenty-six GAS strains responsible for invasive infections (II) and 57 for non-II or colonization were isolated from patients (n = 66) or healthcare workers (n = 13). Seventy strains shared the same molecular markers and 69 the same PFGE pattern; 56 were sequenced. They all belonged to the emerging emm89 clade 3; all but 1 were clonal. Whole genome sequencing identified 43 genetic profiles with sporadic mutations in regulatory genes and acquired mutations in 2 structural genes. Except for two regulatory gene mutants, all strains tested had the same biofilm formation capacity and displayed similar adherence and invasion of pulmonary epithelial cells and phagocytosis and survival in human macrophages. This large outbreak of GAS infection in a post-surgery oncology unit, a setting that contains highly susceptible patients, arose from a strain of the emergent emm89 clade. No relationship between punctual or acquired mutations, invasive status, and strain phenotypic characteristics was found. Noteworthy, the phenotypic characteristics of this clone account for its emergence and its remarkable capacity to elicit outbreaks.

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Zusatzmaterial
Figure S1. The outbreak emm89-F isolates form substantial biofilms compared to other non-emm89 GAS strains. A tendency curve was calculated using the means shown in Fig. 4, y = 0.0362 x + 8.8 excluding the mutants in regulatory genes. The sampling year is indicated below. Symbols are the same as in Fig. 1 (TIFF 1521 KB)
430_2018_546_MOESM1_ESM.tiff
Supplementary material 2 (DOCX 56 KB)
430_2018_546_MOESM2_ESM.docx
Supplementary material 3 (DOCX 23 KB)
430_2018_546_MOESM3_ESM.docx
Supplementary material 4 (XLSX 26 KB)
430_2018_546_MOESM4_ESM.xlsx
Literatur
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