K. Loens AZ KLINA 12/03/2015 NRC invasive hemolytic streptococci not belonging to Group B: epidemiology Role: NRC -hemolytic streptococci not belonging to Group B Confirmation of identification S. pyogenes Since August 2014 also S. dysgalactiae and zoonotic Streptococci (eg. S. equi) Antibiotic susceptibility testing: MIC, Triple disc Erythromycine and tetracycline resistance genes Monitoring of circulating strains by typing Emm-typing Detection of virulence genes (SpeA, ssA and SpeC) Investigation of outbreaks PFGE Participation in international surveillance-activities Biobank Yearnr of invasive strains received/total nr of strains received Nr of invasive strains received from labs submitting on a regular basis / / / / / / Invasive streptococcal strains received at the NRC ( ) Isolation site of invasive -hemolytic streptococci not belonging to Group B Isolation site% blood74.0 Sterile wounds6.2 tissue4.2 Pleural fluid2.1 Other sterile sites (CSF, peritoneal fluid, synovial fluid, sterile not specified) 13.5 Antibiotic resistance in -hemolytic streptococci not belonging to Group B ( ) YearPenicillins (%) Erythromycin R/I (%) Clindamycin resistance / inducible resistance (%) Tetracycline R/I (%) 2009 a 03.2/00/1.67.1/ b 02.1/01.4/0.77.0/ c 03.4/0.90.9/0.98.6/ /5.71.3/6.16.5/ * / * / a available for 187/192 strains b available for 143/195 strains c available for 116/197 strains * Norm EU-CAST Emm-types invasive S. dysgalactiae ( ) YearEmm-types 2009*/ 2010*stG *stG652 (2x), stC74, stG643, stG *stC2sk 2013*/ 2014stC74, stG485, stG62647, stG643 *emm-typing only done for GAS associated with invasive infections common emm-types Kittang et al Eur. J. Clin. Microbiol. Infect. Dis. Loubinoux et al J. Clin. Microbiol. Oppegaard et al Eur. J. Clin. Microbiol. Infect. Dis. Top 4 emm-types invasive GAS strains ( ) YearMost frequent (%) 2nd (%)3rd (%)4th (%) 2009emm1 (21.9)emm89 (13.5)emm3 (13.0)emm12 (7.8) 2010emm1 (16.4)emm28 (12.3)emm6 (9.2)emm3 (8.7) 2011emm1 (23.4)emm3 (12.5)emm28 (9.9)emm6 (7.8) 2012emm1 (20.9)emm3 (12.6)emm75 (10.2)emm89 (7.0) 2013emm1 (30.2)emm3 (13.5)emm89 (8.8)emm28 (6.5) 2014emm1 (19.5)emm89 (13.3)emm6 (6.6) emm75 (6.6) emm3 (6.2) Invasive GAS in children