Antimicrobial resistance of Group A streptococcus isolates from patients in Shenzhen, China during COVID-19 pandemic

Antimicrobial resistance of Group A streptococcus isolates from patients in Shenzhen, China during COVID-19 pandemic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Antimicrobial resistance of Group A streptococcus isolates from patients in Shenzhen, China during COVID-19 pandemic Qinghua Lu, Dingle Yu, Yunmei Liang, Qing Meng, Senfen Wang, Zihao Liu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6738371/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jan, 2026 Read the published version in BMC Pediatrics → Version 1 posted 10 You are reading this latest preprint version Abstract Background Group a streptococcus (GAS) is one of the few bacterial pathogens that can cause a wide range of infectious diseases and autoimmune diseases. Human beings are the only host of GAS, which is mainly transmitted through airborne droplets and skin mucous membrane contact. The COVID-19 pandemic has changed our way of life. The objective of this study was to investigate the antimicrobial resistance, emm typing and multilocus sequence type (MLST) of GAS isolates from patients in Shenzhen children’s Hospital during COVID-19 pandemic. Methods We collected GAS strains that were isolated, identified and stored in patients (0-18 years old) who visited the outpatient department or ward of Shenzhen Children's Hospital from January 2019 to December 2020. Antimicrobial susceptibility test was performed according to the distribution of conventional antibiotics and Clinical and Laboratory Standards Institute (CLSI) recommendations. The distribution of the macrolide-resistance genes (ermB, ermA, mefA) and tetracycline-resistance gene （tetM， tetO）, emm (M protein-coding gene) typing and multilocus sequence type (MLST) were examined by polymerase chain reaction (PCR). Results All the 124 GAS strains were sensitive to penicillin, and 95.2% were sensitive to levofloxacin. Most strains were resistant to clindamycin, azithromycin, clarithromycin, erythromycin and tetracycline, and the resistance rates were 73.4% (91/124), 78.2% (97/124), 78.2% (97/124), 78.2% (97/124), 75.0% (93/124), respectively. The resistance rate of chloramphenicol was 3.2% (4/124). The rate of macrolide-resistance genes was as follows: 99 strains (79.8%) carried ermB, 55 strains (44.0%) carried ermA, 56 strains (45.1%) carried mefA; Tetracycline-resistance genes carried: 58 strains (46.7%) carried tetO, 100 strains (80.6%) carried tetM; 94 strains carried ermB and tetM together, accounting for 75.8%. A total of 12 emm types were detected in this study. The emm types of 71 GAS isolates were mainly emm1, emm3, emm4, emm6, emm12, emm74, emm75, emm88, emm89 and emm110 in 2019. While emm types of 53 GAS isolates were mainly emm1, emm2, emm3, emm4, emm12 and emm22 in 2020. The clones carrying both Erythromycin-resistance and tetracycline-resistance genes were ST36/emm12, ST28/emm1, ST15/emm3 and ST39/ emm4. Conclusions Under COVID-19 pandemic, our collections of GAS strains decreased dramatically. The resistance rate of GAS strains in 2020 increased slightly compared with 2019. The main emm types analysis of GAS infections among children during COVID-19 pandemic was not significantly different from our previous study. On the whole, Continuous surveillance of antibiotics resistance pattern of GAS must be strengthen to improve the reasonable use of antibiotics in hospitals. Group A Streptococcus Antimicrobial resistance emm typing Multilocus Sequence Typing Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Jan, 2026 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 05 Aug, 2025 Reviews received at journal 29 Jul, 2025 Reviewers agreed at journal 24 Jul, 2025 Reviews received at journal 12 Jul, 2025 Reviewers agreed at journal 10 Jul, 2025 Reviewers invited by journal 23 Jun, 2025 Editor invited by journal 20 Jun, 2025 Editor assigned by journal 02 Jun, 2025 Submission checks completed at journal 02 Jun, 2025 First submitted to journal 24 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6738371","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475175558,"identity":"3c6c1e3e-848a-42aa-94bf-269f35480151","order_by":0,"name":"Qinghua Lu","email":"","orcid":"","institution":"Shenzhen Children's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qinghua","middleName":"","lastName":"Lu","suffix":""},{"id":475175559,"identity":"d24e694b-11e1-4723-b851-cdc0d35b2f11","order_by":1,"name":"Dingle Yu","email":"","orcid":"","institution":"Shenzhen Children's 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Human beings are the only host of GAS, which is mainly transmitted through airborne droplets and skin mucous membrane contact. The COVID-19 pandemic has changed our way of life. The objective of this study was to investigate the antimicrobial resistance, emm typing and multilocus sequence type (MLST) of GAS isolates from patients in Shenzhen children’s Hospital during COVID-19 pandemic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eWe collected GAS strains that were isolated, identified and stored in patients (0-18 years old) who visited the outpatient department or ward of Shenzhen Children's Hospital from January 2019 to December 2020. Antimicrobial susceptibility test was performed according to the distribution of conventional antibiotics and Clinical and Laboratory Standards Institute (CLSI) recommendations. The distribution of the macrolide-resistance genes (ermB, ermA, mefA) and tetracycline-resistance gene （tetM， tetO）, emm (M protein-coding gene) typing and multilocus sequence type (MLST) were examined by polymerase chain reaction (PCR).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eAll the 124 GAS strains were sensitive to penicillin, and 95.2% were sensitive to levofloxacin. Most strains were resistant to clindamycin, azithromycin, clarithromycin, erythromycin and tetracycline, and the resistance rates were 73.4% (91/124), 78.2% (97/124), 78.2% (97/124), 78.2% (97/124), 75.0% (93/124), respectively. The resistance rate of chloramphenicol was 3.2% (4/124). The rate of macrolide-resistance genes was as follows: 99 strains (79.8%) carried ermB, 55 strains (44.0%) carried ermA, 56 strains (45.1%) carried mefA; Tetracycline-resistance genes carried: 58 strains (46.7%) carried tetO, 100 strains (80.6%) carried tetM; 94 strains carried ermB and tetM together, accounting for 75.8%. A total of 12 emm types were detected in this study. The emm types of 71 GAS isolates were mainly emm1, emm3, emm4, emm6, emm12, emm74, emm75, emm88, emm89 and emm110 in 2019. While emm types of 53 GAS isolates were mainly emm1, emm2, emm3, emm4, emm12 and emm22 in 2020. The clones carrying both Erythromycin-resistance and tetracycline-resistance genes were ST36/emm12, ST28/emm1, ST15/emm3 and ST39/ emm4.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eUnder COVID-19 pandemic, our collections of GAS strains decreased dramatically. The resistance rate of GAS strains in 2020 increased slightly compared with 2019. The main emm types analysis of GAS infections among children during COVID-19 pandemic was not significantly different from our previous study. On the whole, Continuous surveillance of antibiotics resistance pattern of GAS must be strengthen to improve the reasonable use of antibiotics in hospitals.\u003c/p\u003e","manuscriptTitle":"Antimicrobial resistance of Group A streptococcus isolates from patients in Shenzhen, China during COVID-19 pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-25 04:27:46","doi":"10.21203/rs.3.rs-6738371/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-05T15:22:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-29T09:07:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30049499244938905754674648819003684342","date":"2025-07-24T05:32:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-12T06:00:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277485236348395350007485376737697067543","date":"2025-07-10T07:03:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-23T12:36:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-20T04:17:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-02T07:35:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-02T07:33:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-05-24T09:59:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e3316775-81fb-4e2d-bacb-f7536ae84e83","owner":[],"postedDate":"June 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:14:44+00:00","versionOfRecord":{"articleIdentity":"rs-6738371","link":"https://doi.org/10.1186/s12887-025-06448-0","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2026-01-09 15:57:54","publishedOnDateReadable":"January 9th, 2026"},"versionCreatedAt":"2025-06-25 04:27:46","video":"","vorDoi":"10.1186/s12887-025-06448-0","vorDoiUrl":"https://doi.org/10.1186/s12887-025-06448-0","workflowStages":[]},"version":"v1","identity":"rs-6738371","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6738371","identity":"rs-6738371","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}