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

Céline Plainvert 1, 2, 3 Magalie Longo 1, 3 Elise Seringe 4 Benjamin Saintpierre 1, 3 Elisabeth Sauvage 5 Laurence Ma 6 Johann Beghain 7 Nicolas Dmytruk 2 Gislène Collobert 2 Eric Hernandez 8 Christian Manuel 8 Pascal Astagneau 9 Philippe Glaser 5 Frederic Ariey 1, 3 Claire Poyart 1, 2, 3, * Agnès Fouet 1, 3
* Corresponding author
1 IC UM3 (UMR 8104 / U1016) - Institut Cochin
2 Centre national de Référence des Streptocoques (CNR)
3 UPD5 - Université Paris Descartes - Paris 5
4 APHP - Assistance publique - Hôpitaux de Paris (AP-HP)
5 EERA - Ecologie et Evolution de la Résistance aux Antibiotiques / Ecology and Evolution of Antibiotics Resistance
6 C2RT - Pôle Biomics
7 Génétique et Génomique des Insectes Vecteurs
8 Centre Médical de Forcilles [Lesigny, France]
9 Sorbonne Université - Faculté de médecine Pitié Salpétrière
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.
Keywords : emm89 Phylogeny Outbreak Group A Streptococcus Biofilm Emerging clade Bacterium–cell interaction
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Journal articles
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Submitted on : Friday, December 14, 2018 - 1:20:45 PM
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Céline Plainvert, Magalie Longo, Elise Seringe, Benjamin Saintpierre, Elisabeth Sauvage, et al.. A clone of the emergent Streptococcus pyogenes emm89 clade responsible for a large outbreak in a post-surgery oncology unit in France. Medical Microbiology and Immunology, Springer Verlag, In press, 207 (5-6), pp.287-296. ⟨10.1007/s00430-018-0546-1⟩. ⟨inserm-01955462⟩

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