Multilocus sequence types in Czech neonatal GBS strains from 2004 to 2008.

The first multilocus sequence typing results of Czech neonatal Streptococcus agalactiae isolates are presented in this paper. The aims of the study were to prove if the Czech isolates belong to potential invasive clonal complex CC17 and to further analyse serotype-sequence type relationships. Twelve sequence types detected among 77 isolates were assigned to 5 clonal complexes. Sequence type variability was found for most of our collection serotypes. As many as 83 % of the invasive isolates were covered by as few as 3 sequence types: S17, ST23 and ST19. ST17 was the only sequence type strictly tied to serotype III. "Hyperinvasive" ST17 was identified in 85 % of the cerebrospinal fluid isolates (6 out of 7), but in 32 % of the blood isolates only.

Emergence of a novel macrolide-resistant Streptococcus pyogenes emm53 strain.

An unusual emm53, T-28/T-non-typeable, iMLS(B) phenotype clone represented a substantial proportion (28.6%) of invasive erythromycin-resistant group A streptococcus (GAS) isolates in the Czech Republic during 2003. Clonal analysis of emm53 isolates between 2001 and 2004 revealed four pulsed-field gel electrophoresis (PFGE) patterns and two emm subtypes. Isolates produced identical PFGE patterns regardless of their invasiveness and/or tetracycline resistance. Multilocus sequence typing classified all isolates as ST340. An ST5 (emm83) isolate, a potential ancestor of ST340, was isolated in the Czech Republic from an impetigo patient in 1988. The Czech emm53/ST340 isolates shared only three of seven alleles with the original Lancefield emm53/ST11 isolate.

[Surveillance of serious diseases caused by group A streptococci in the Czech Republic in 2003--the Strep-EURO project]. / Surveillance závazných onemocnení pusobených streptokoky skupiny A v Ceské republice v roce 2003--projekt Strep-EURO.

Results obtained in the first year of active surveillance of serious diseases caused by group A streptococci in the Czech Republic carried out within the Strep-EURO project are summarized. From January to December 2003, 28 Czech laboratories referred to the National Institute of Public Health 59 group A streptococcal strains isolated from invasive diseases meeting the Strep-EURO definition. At the same time, clinical-epidemiological data and information on the catchment area population were provided. For 2003, the total morbidity and case fatality rates were calculated to be 1.3/100,000 population and 13.5%, respectively. A high proportion (23.7%) of the 59 strains were of type emm 1, initially labeled M1. As many as 24.1%, 17.2% and 20.7% of the strains tested were resistant to erythromycin, clindamycin and tetracycline, respectively. The seemingly lower morbidity rate and higher case fatality rate from serious diseases caused by group A streptococci reported in the Czech Republic for 1994-1996, i.e. 0.4/100,000 and 46.5%, respectively, in comparison with the latest data can be explained by the use of softer international criteria for the Strep-EURO definition of invasive disease.

Vaginal & rectal carriage of Streptococcus agalactiae in the Czech Republic: incidence, serotypes distribution & susceptibility to antibiotics.

BACKGROUND & OBJECTIVES: Streptococcus agalactiae (group B streptococcus, GBS) is the predominant bacterial agent responsible for invasive perinatal infection. To obtain reliable data on vaginal and rectal carriage of S. agalactiae in pregnant women in Czech Republic, and to formulate a prevention programme of neonatal GBS disease for the Czech Republic, women at childbirth were screened for vaginal and anorectal carriage of GBS. The isolates were serotyped and tested for susceptibility to antimicrobials including those recommended for intrapartum prophylaxis. METHODS: A total of 586 women at childbirth were screened for GBS carriage in vaginal and anorectal regions using the non-enrichment and selective culture media. The isolates were serotyped by precipitation with antisera raised against various serotypes and antigenic extracts prepared according to Lancefield's modification. Mueller Hinton agar with 5 per cent defibrinated sheep blood was used for antimicrobial susceptibility testing. MIC values were evaluated according to the NCCLS criteria. RESULTS: Using selective media, GBS was detected in 172 (29.3%) of 586 women screened, vaginal and anorectal colonization was found in 21.7 and 24.4 per cent of them, respectively, concomitant vaginal and anorectal colonization was recorded in 16.5 per cent of the women studied. Serotypes III (33.2%), Ia (22.0%) and V (13.9%) prevailed among 172 isolates tested. All isolates were susceptible to penicillin, ampicillin and cefotaxime. The rates of GBS resistance to tetracycline, erythromycin and clindamycin were 83.9, 3.8 and 3.2 per cent, respectively. INTERPRETATION & CONCLUSION: GBS carriage in pregnant women in the Czech Republic is rather high as compared with that reported in literature. The most frequent serotypes III, Ia and V, identified in GBS-colonized pregnant women in the Czech Republic, were among those predominant in the USA and Western Europe. Our findings confirm uniform susceptibility of GBS isolates from pregnant women to penicillin and other beta-lactam antibiotics tested. Resistance to erythromycin remains low in the Czech Republic.

Active surveillance of early onset disease due to group B streptococci in newborns.

BACKGROUND & OBJECTIVES: Early onset disease (EOD) due to group B streptococci (GBS) poses a serious threat in many countries. In the Czech Republic neither summarized data on the EOD incidence are available nor a nationwide prevention program has been initiated. The present surveillance was initiated to establish the incidence of EOD due to GBS in newborns in the Czech Republic, distribution of GBS serotypes and GBS susceptibility to antimicrobials. METHODS: Both invasive and carrier GBS isolates from newborns and the data on the newborns' clinical status and maternal colonization and intrapartum prophylaxis were collected from 30 microbiological and clinical centres all over the Czech Republic within prospective active surveillance. HCl extracts of the GBS strains were precipitated with rabbit polysaccharide (I-VIII) and protein (c,R) antisera. RESULTS: Between January 2001 and September 2002, GBS isolates from 239 full-term and 46 preterm newborns were collected. Of the 285 GBS positive newborns, 105 had invasive EOD, 42 showed suspected EOD, and in 56 clinical diagnosis was not specified. Eighty two GBS isolates were obtained from healthy colonized infants. The isolates obtained from newborns with confirmed invasive EOD were mostly of serotype III (42%), followed by serotypes V a Ia (13% each). Types Ia (26%), III (22%) and II (20%) were most frequent among the isolates from colonized individuals. Protein antigens (c protein, R protein) either coupled with polysaccharide or alone were found in 70 per cent (30 and 40 %, respectively) of the study isolates. INTERPRETATION & CONCLUSION: The incidence of EOD due to GBS found in the Czech Republic 0.7-1.0 per 1000 live births was comparable with the rates reported in the countries where the prevention programme has been implemented nationwide. Serotypes III, V and Ia prevailing among the isolates from Czech newborns with EOD belonged to those most frequently identified in the USA and Western European countries.

[Multilocus sequence typing of group A streptococci isolated from invasive diseases in the Czech Republic in 2003]. / Multilokusová sekvenacní typizace streptokoku skupiny A izolovaných z invazivních onemocnení v Ceské republice v roce 2003.

First results of multilocus sequence typing (MLST) for characterization of 29 invasive Streptococcus pyogenes strains isolated in the Czech Republic in the first half of 2003 are presented. None of 16 emm types detected among the study strains showed sequence type (ST) variability. The MLST results are indicative of differences between the strains causing serious diseases in the Czech Republic and those isolated in other countries. In seven strains, four new STs with known alleles in new combinations, ST134, ST308, ST336, ST340, and one new ST with three as yet undescribed alleles (gki 91, murI 65 and yqiL 60), ST341, were described. These newly described STs were submitted to the web-based reference MLST database for S. pyogenes.