Streptococcus pyogenes in Neonates and Postpartum Women: First Report on Prevalence, Resistance, emm Typing, and Risk Factors in Khyber Pakhtunkhwa

Ahmad SS, Abid L, Khalid A. Antimicrobial susceptibility patterns of bacteria associated with upper respiratory tract infections in North and South Waziristan, Pakistan. J Health Rehabil Res. 2024;4(3):1–5. https://doi.org/10.61919/jhrr.v4i3.1582 Ahmad SS Abid L Khalid A. Antimicrobial susceptibility patterns of bacteria associated with upper respiratory tract infections in North and South Waziristan, Pakistan . J Health Rehabil Res . 2024 ; 4 ( 3 ): 1 – 5 . https://doi.org/10.61919/jhrr.v4i3.1582 Search in Google Scholar

Akram S, Khan MA, Khan SA, Shah HBU. Group A beta hemolytic streptococcal carriage and antibiotic sensitivity among school going children in Mardan, Pakistan. J Postgrad Med Inst. 2021;35(1):36–39. https://doi.org/10.54079/jpmi.35.1.2694 Akram S Khan MA Khan SA Shah HBU. Group A beta hemolytic streptococcal carriage and antibiotic sensitivity among school going children in Mardan, Pakistan . J Postgrad Med Inst . 2021 ; 35 ( 1 ): 36 – 39 . https://doi.org/10.54079/jpmi.35.1.2694 Search in Google Scholar

Arêas GP, Schuab RB, Neves FP, Barros RR. Antimicrobial susceptibility patterns, emm type distribution and genetic diversity of Streptococcus pyogenes recovered in Brazil. Mem Inst Oswaldo Cruz. 2014 Nov;109(7):935–939. https://doi.org/10.1590/0074-0276140231 Arêas GP Schuab RB Neves FP Barros RR. Antimicrobial susceptibility patterns, emm type distribution and genetic diversity of Streptococcus pyogenes recovered in Brazil . Mem Inst Oswaldo Cruz . 2014 Nov ; 109 ( 7 ): 935 – 939 . https://doi.org/10.1590/0074-0276140231 Search in Google Scholar

Assafi MS. Frequency and antibiogram of Streptococcus spp isolated from different specimens: Three years of study. Cell Mol Biol. 2023 Apr;69(4):24–30. https://doi.org/10.14715/cmb/2023.69.4.4 Assafi MS. Frequency and antibiogram of Streptococcus spp isolated from different specimens: Three years of study . Cell Mol Biol . 2023 Apr ; 69 ( 4 ): 24 – 30 . https://doi.org/10.14715/cmb/2023.69.4.4 Search in Google Scholar

Berwal A, Chawla K, Shetty S, Gupta A. Trend of antibiotic susceptibility of Streptococcus pyogenes isolated from respiratory tract infections in tertiary care hospital in south Karnataka. Iran J Microbiol. 2019 Feb;11(1):13–18. Berwal A Chawla K Shetty S Gupta A. Trend of antibiotic susceptibility of Streptococcus pyogenes isolated from respiratory tract infections in tertiary care hospital in south Karnataka . Iran J Microbiol . 2019 Feb ; 11 ( 1 ): 13 – 18 . Search in Google Scholar

Bilal H, Khan MN, Rehman T, Hameed MF, Yang X. Antibiotic resistance in Pakistan: A systematic review of past decade. BMC Infect Dis. 2021 Mar;21(1):244. https://doi.org/10.1186/s12879-021-05906-1 Bilal H Khan MN Rehman T Hameed MF Yang X. Antibiotic resistance in Pakistan: A systematic review of past decade . BMC Infect Dis . 2021 Mar ; 21 ( 1 ): 244 . https://doi.org/10.1186/s12879-021-05906-1 Search in Google Scholar

Birrie E, Sisay E, Tibebu NS, Tefera BD, Zeleke M, Tefera Z. Neonatal sepsis and associated factors among newborns in Woldia and Dessie Comprehensive Specialized Hospitals, North-East Ethiopia, 2021. Infect Drug Resist. 2022 Aug;15:4169–4179. https://doi.org/10.2147/idr.s374835 Birrie E Sisay E Tibebu NS Tefera BD Zeleke M Tefera Z. Neonatal sepsis and associated factors among newborns in Woldia and Dessie Comprehensive Specialized Hospitals, North-East Ethiopia, 2021 . Infect Drug Resist . 2022 Aug ; 15 : 4169 – 4179 . https://doi.org/10.2147/idr.s374835 Search in Google Scholar

Bonomo C, Mannino E, Bongiorno D, Vocale C, Amicucci A, Bivona D, Guariglia D, Nicitra E, Privitera GF, Sangiorgio G, et al. Molecular and clinical characterization of invasive Streptococcus pyogenes isolates: Insights from two Northern-Italy Centers. Pathogens. 2025 Feb;14(2):152. https://doi.org/10.3390/patho-gens14020152 Bonomo C Mannino E Bongiorno D Vocale C Amicucci A Bivona D Guariglia D Nicitra E Privitera GF Sangiorgio G Molecular and clinical characterization of invasive Streptococcus pyogenes isolates: Insights from two Northern-Italy Centers . Pathogens . 2025 Feb ; 14 ( 2 ): 152 . https://doi.org/10.3390/patho-gens14020152 Search in Google Scholar

Camara M, Dieng A, Boye CS. Antibiotic susceptibility of Streptococcus pyogenes isolated from respiratory tract infections in Dakar, Senegal. Microbiol Insights. 2013 Oct;6:71–75. https://doi.org/10.4137/mbi.s12996 Camara M Dieng A Boye CS. Antibiotic susceptibility of Streptococcus pyogenes isolated from respiratory tract infections in Dakar, Senegal . Microbiol Insights . 2013 Oct ; 6 : 71 – 75 . https://doi.org/10.4137/mbi.s12996 Search in Google Scholar

CLSI. Performance standards for antimicrobial susceptibility testing. 33^rd ed. CLSI supplement M100. Wayne (USA): Clinical and Laboratory Standards Institute; 2023. CLSI Performance standards for antimicrobial susceptibility testing . 33 ^rd ed. CLSI supplement M100 . Wayne (USA) : Clinical and Laboratory Standards Institute ; 2023 . Search in Google Scholar

Cohen-Poradosu R, Kasper DL. Group A Streptococcus epidemiology and vaccine implications. Clin Infect Dis. 2007 Oct;45(7):863–865. https://doi.org/10.1086/521263 Cohen-Poradosu R Kasper DL. Group A Streptococcus epidemiology and vaccine implications . Clin Infect Dis . 2007 Oct ; 45 ( 7 ): 863 – 865 . https://doi.org/10.1086/521263 Search in Google Scholar

Cortés-Penfield N, Ryder JH. Should linezolid replace clindamycin as the adjunctive antimicrobial of choice in group a streptococcal necrotizing soft tissue infection and toxic shock syndrome? A focused debate. Clin Infect Dis. 2023 Jan 13;76(2):346-350. https://doi.org/10.1093/cid/ciac720 Cortés-Penfield N Ryder JH. Should linezolid replace clindamycin as the adjunctive antimicrobial of choice in group a streptococcal necrotizing soft tissue infection and toxic shock syndrome? A focused debate . Clin Infect Dis . 2023 Jan 13 ; 76 ( 2 ): 346 - 350 . https://doi.org/10.1093/cid/ciac720 Search in Google Scholar

Creti R, Imperi M, Baldassarri L, Pataracchia M, Recchia S, Alfarone G, Orefici G. emm Types, virulence factors, and antibiotic resistance of invasive Streptococcus pyogenes isolates from Italy: What has changed in 11 years? J Clin Microbiol. 2007 Jul;45(7):2249–2256. https://doi.org/10.1128/jcm.00513-07 Creti R Imperi M Baldassarri L Pataracchia M Recchia S Alfarone G Orefici G. emm Types, virulence factors, and antibiotic resistance of invasive Streptococcus pyogenes isolates from Italy: What has changed in 11 years? J Clin Microbiol . 2007 Jul ; 45 ( 7 ): 2249 – 2256 . https://doi.org/10.1128/jcm.00513-07 Search in Google Scholar

Donders G, Greenhouse P, Donders F, Engel U, Paavonen J, Mendling W. Genital tract GAS infection ISIDOG guidelines. J Clin Med. 2021 May;10(9):2043. https://doi.org/10.3390/jcm10092043 Donders G Greenhouse P Donders F Engel U Paavonen J Mendling W. Genital tract GAS infection ISIDOG guidelines . J Clin Med . 2021 May ; 10 ( 9 ): 2043 . https://doi.org/10.3390/jcm10092043 Search in Google Scholar

Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlap-bach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: A systematic review. Lancet Respir Med. 2018 Mar;6(3):223–230. https://doi.org/10.1016/S2213-2600(18)30063-8 Fleischmann-Struzek C Goldfarb DM Schlattmann P Schlap-bach LJ Reinhart K Kissoon N. The global burden of paediatric and neonatal sepsis: A systematic review . Lancet Respir Med . 2018 Mar ; 6 ( 3 ): 223 – 230 . https://doi.org/10.1016/S2213-2600(18)30063-8 Search in Google Scholar

Frost HR, Davies MR, Velusamy S, Delforge V, Erhart A, Darboe S, Steer A, Walker MJ, Beall B, Botteaux A, et al. Updated emm-typing protocol for Streptococcus pyogenes. Clin Microbiol Infect. 2020 Jul;26(7):946.e5–946.e8. https://doi.org/10.1016/j.cmi.2020.02.026 Frost HR Davies MR Velusamy S Delforge V Erhart A Darboe S Steer A Walker MJ Beall B Botteaux A Updated emm-typing protocol for Streptococcus pyogenes . Clin Microbiol Infect . 2020 Jul ; 26 ( 7 ): 946.e5 – 946.e8 . https://doi.org/10.1016/j.cmi.2020.02.026 Search in Google Scholar

Gashaw Y, Getaneh A, Kasew D, Tigabie M, Gelaw B. Streptococcus pyogenes carriage rate, associated factors and antimicrobial susceptibility profiles among urban and rural schoolchildren at Gondar city, Northwest Ethiopia. Sci Rep. 2025 Jan;15(1):2057. https://doi.org/10.1038/s41598-024-82009-2 Gashaw Y Getaneh A Kasew D Tigabie M Gelaw B. Streptococcus pyogenes carriage rate, associated factors and antimicrobial susceptibility profiles among urban and rural schoolchildren at Gondar city, Northwest Ethiopia . Sci Rep . 2025 Jan ; 15 ( 1 ): 2057 . https://doi.org/10.1038/s41598-024-82009-2 Search in Google Scholar

Gebre AB, Fenta DA, Negash AA, Hayile BJ. Prevalence, antibiotic susceptibility pattern and associated factors of Streptococcus pyogenes among pediatric patients with acute pharyngitis in Sidama, Southern Ethiopia. Int J Microbiol. 2024 Sep;2024:9282571. https://doi.org/10.1155/2024/9282571 Gebre AB Fenta DA Negash AA Hayile BJ. Prevalence, antibiotic susceptibility pattern and associated factors of Streptococcus pyogenes among pediatric patients with acute pharyngitis in Sidama, Southern Ethiopia . Int J Microbiol . 2024 Sep ; 2024 : 9282571 . https://doi.org/10.1155/2024/9282571 Search in Google Scholar

Gergova R, Boyanov V, Muhtarova A, Alexandrova A. A review of the impact of streptococcal infections and antimicrobial resistance on human health. Antibiotics. 2024 Apr;13(4):360. https://doi.org/10.3390/antibiotics13040360 Gergova R Boyanov V Muhtarova A Alexandrova A. A review of the impact of streptococcal infections and antimicrobial resistance on human health . Antibiotics . 2024 Apr ; 13 ( 4 ): 360 . https://doi.org/10.3390/antibiotics13040360 Search in Google Scholar

Haggar A, Nerlich A, Kumar R, Abraham VJ, Brahmadathan KN, Ray P, Dhanda V, Joshua JM, Mehra N, Bergmann R, et al. Clinical and microbiologic characteristics of invasive Streptococcus pyogenes infections in north and south India. J Clin Microbiol. 2012 May;50(5):1626–1631. https://doi.org/10.1128/jcm.06697-11 Haggar A Nerlich A Kumar R Abraham VJ Brahmadathan KN Ray P Dhanda V Joshua JM Mehra N Bergmann R Clinical and microbiologic characteristics of invasive Streptococcus pyogenes infections in north and south India . J Clin Microbiol . 2012 May ; 50 ( 5 ): 1626 – 1631 . https://doi.org/10.1128/jcm.06697-11 Search in Google Scholar

Hall JN, Armitage EP, Senghore E, Darboe S, Barry M, Camara J, Bah S, Keeley AJ, McCarthy JS, Smeesters P, et al. Molecular methods enhance the detection of pyoderma-related Streptococcus pyogenes and emm-type distribution in children. J Infect Dis. 2025 Feb;231(1):e28–e37. https://doi.org/10.1093/infdis/jiae359 Hall JN Armitage EP Senghore E Darboe S Barry M Camara J Bah S Keeley AJ McCarthy JS Smeesters P et al . Molecular methods enhance the detection of pyoderma-related Streptococcus pyogenes and emm-type distribution in children. J Infect Dis . 2025 Feb ; 231 ( 1 ): e28 – e37 . https://doi.org/10.1093/infdis/jiae359 Search in Google Scholar

Hariri SHM, Ibrahim NR, Noraida R, Ismail AA, Anani Aila MZ, Hajissa K, Zeehaida M. Group A Streptococcus puerperal sepsis with invasive neonatal infection: A fatal case. Med J Malaysia. 2021 Sep;76(5):731–733. Hariri SHM Ibrahim NR Noraida R Ismail AA Anani Aila MZ Hajissa K Zeehaida M. Group A Streptococcus puerperal sepsis with invasive neonatal infection: A fatal case . Med J Malaysia . 2021 Sep ; 76 ( 5 ): 731 – 733 . Search in Google Scholar

Harris K, Proctor LK, Shinar S, Philippopoulos E, Yudin MH, Murphy KE. Outcomes and management of pregnancy and puerperal group A streptococcal infections: A systematic review. Acta Obstet Gynecol Scand. 2023 Feb;102(2):138–157. https://doi.org/10.1111/aogs.14500 Harris K Proctor LK Shinar S Philippopoulos E Yudin MH Murphy KE. Outcomes and management of pregnancy and puerperal group A streptococcal infections: A systematic review . Acta Obstet Gynecol Scand . 2023 Feb ; 102 ( 2 ): 138 – 157 . https://doi.org/10.1111/aogs.14500 Search in Google Scholar

Hassan IA, Onon TS, Weston D, Isalska B, Wall K, Afshar B, Efst-ratiou A. A quantitative descriptive study of the prevalence of carriage (colonisation) of haemolytic streptococci groups A, B, C and G in pregnancy. J Obstet Gynaecol. 2011;31(3):207–209. https://doi.org/10.3109/01443615.2010.541570 Hassan IA Onon TS Weston D Isalska B Wall K Afshar B Efst-ratiou A. A quantitative descriptive study of the prevalence of carriage (colonisation) of haemolytic streptococci groups A, B, C and G in pregnancy . J Obstet Gynaecol . 2011 ; 31 ( 3 ): 207 – 209 . https://doi.org/10.3109/01443615.2010.541570 Search in Google Scholar

Hazelhorst EI, van Ewijk CE, Wielders CCH, Te Wierik MJM, Hahné SJM, de Melker HE, Knol MJ, de Gier B. Risk factors for invasive group A streptococcal infection in children aged 6 months to 5 years: A case-control study, the Netherlands, February-May 2023. Epidemiol Infect. 2025 Mar 27;153:e57. https://doi.org/10.1017/S0950268825000275 Hazelhorst EI van Ewijk CE Wielders CCH Te Wierik MJM Hahné SJM de Melker HE Knol MJ de Gier B. Risk factors for invasive group A streptococcal infection in children aged 6 months to 5 years: A case-control study, the Netherlands, February-May 2023 . Epidemiol Infect . 2025 Mar 27 ; 153 : e57 . https://doi.org/10.1017/S0950268825000275 Search in Google Scholar

Cooper JD, Cooper SR, Wolk DM, Tice AM, Persing TF, Esolen LM. Postpartum Streptococcus pyogenes outbreak in the labor and delivery unit of a quaternary referral center: A case series and review of the literature. Clin Microbiol Newsl. 2017 Jan;39(2):11–15. https://doi.org/10.1016/j.clinmicnews.2016.12.003 Cooper JD Cooper SR Wolk DM Tice AM Persing TF Esolen LM. Postpartum Streptococcus pyogenes outbreak in the labor and delivery unit of a quaternary referral center: A case series and review of the literature . Clin Microbiol Newsl . 2017 Jan ; 39 ( 2 ): 11 – 15 . https://doi.org/10.1016/j.clinmicnews.2016.12.003 Search in Google Scholar

Khademi F, Vaez H, Sahebkar A, Taheri RA. Group A Streptococcus antibiotic resistance in Iranian children: A meta-analysis. Oman Med J. 2021 Jan;36(1):e222. https://doi.org/10.5001/omj.2020.79 Khademi F Vaez H Sahebkar A Taheri RA. Group A Streptococcus antibiotic resistance in Iranian children: A meta-analysis . Oman Med J . 2021 Jan ; 36 ( 1 ): e222 . https://doi.org/10.5001/omj.2020.79 Search in Google Scholar

Khan RMA, Anwar S, Pirzada ZA. Streptococcus pyogenes strains associated with invasive and non-invasive infections present possible links with emm types and superantigens. Iran J Basic Med Sci. 2020 Jan;23(1):133–139. https://doi.org/10.22038/IJBMS.2019.38635.9164 Khan RMA Anwar S Pirzada ZA. Streptococcus pyogenes strains associated with invasive and non-invasive infections present possible links with emm types and superantigens . Iran J Basic Med Sci . 2020 Jan ; 23 ( 1 ): 133 – 139 . https://doi.org/10.22038/IJBMS.2019.38635.9164 Search in Google Scholar

Khandekar A, Dangre-Mudey G. Tackling rheumatic heart disease: Prevalence and antibiogram of Streptococcus pyogenes in cases of paediatric pharyngitis. J Clin Diagn Res. 2019;13(2):11–13. https://doi.org/10.7860/JCDR/2019/38486.12626 Khandekar A Dangre-Mudey G. Tackling rheumatic heart disease: Prevalence and antibiogram of Streptococcus pyogenes in cases of paediatric pharyngitis . J Clin Diagn Res . 2019 ; 13 ( 2 ): 11 – 13 . https://doi.org/10.7860/JCDR/2019/38486.12626 Search in Google Scholar

Koutouzi F, Tsakris A, Chatzichristou P, Koutouzis E, Daikos GL, Kirikou E, Petropoulou N, Syriopoulou V, Michos A. Streptococcus pyogenes emm types and clusters during a 7-year period (2007 to 2013) in pharyngeal and nonpharyngeal pediatric isolates. J Clin Microbiol. 2015 Jul;53(7):2015–2021. https://doi.org/10.1128/JCM.00301-15 Koutouzi F Tsakris A Chatzichristou P Koutouzis E Daikos GL Kirikou E Petropoulou N Syriopoulou V Michos A. Streptococcus pyogenes emm types and clusters during a 7-year period (2007 to 2013) in pharyngeal and nonpharyngeal pediatric isolates . J Clin Microbiol . 2015 Jul ; 53 ( 7 ): 2015 – 2021 . https://doi.org/10.1128/JCM.00301-15 Search in Google Scholar

Leclercq R, Courvalin P. Bacterial resistance to macrolide, lincosamide, and streptogramin antibiotics by target modification. Antimicrob Agents Chemother. 1991 Jul;35(7):1267–1272. https://doi. org/10.1128/AAC.35.7.1267 Leclercq R Courvalin P. Bacterial resistance to macrolide, lincosamide, and streptogramin antibiotics by target modification . Antimicrob Agents Chemother . 1991 Jul ; 35 ( 7 ): 1267 – 1272 . https://doi. org/10.1128/AAC.35.7.1267 Search in Google Scholar

Leonard A, Wright A, Saavedra-Campos M, Lamagni T, Cordery R, Nicholls M, Domoney C, Sriskandan S, Balasegaram S. Severe group A streptococcal infections in mothers and their newborns in London and the South East, 2010–2016: assessment of risk and audit of public health management. BJOG. 2019 Jan;126(1):44-53. https://doi.org/10.1111/1471-0528.15415 Leonard A Wright A Saavedra-Campos M Lamagni T Cordery R Nicholls M Domoney C Sriskandan S Balasegaram S. Severe group A streptococcal infections in mothers and their newborns in London and the South East, 2010–2016: assessment of risk and audit of public health management . BJOG . 2019 Jan ; 126 ( 1 ): 44 - 53 . https://doi.org/10.1111/1471-0528.15415 Search in Google Scholar

Li Y, Lyu Y, Xue F, Zheng B, Zhang X, Hu Y, Jin Y, Hu Z, Zhao J, Pan S, et al. Antimicrobial susceptibility of gram-positive organisms: Results from China Antimicrobial Resistance Surveillance Trial Program, 2013–2014. Chin J Lab Med. 2016;39:120–129. https://doi.org/10.3760/CMA.J.ISSN.1009-9158.2016.02.010 Li Y Lyu Y Xue F Zheng B Zhang X Hu Y Jin Y Hu Z Zhao J Pan S Antimicrobial susceptibility of gram-positive organisms: Results from China Antimicrobial Resistance Surveillance Trial Program, 2013–2014 . Chin J Lab Med . 2016 ; 39 : 120 – 129 . https://doi.org/10.3760/CMA.J.ISSN.1009-9158.2016.02.010 Search in Google Scholar

Li Y, Rivers J, Mathis S, Li Z, McGee L, Chochua S, Metcalf BJ, Fleming-Dutra KE, Nanduri SA, Beall B. Continued increase of erythromycin nonsusceptibility and clindamycin nonsusceptibility among invasive group A streptococci driven by genomic clusters, United States, 2018–2019. Clin Infect Dis. 2023 Feb;76(3):e1266–e1269. https://doi.org/10.1093/cid/ciac468 Li Y Rivers J Mathis S Li Z McGee L Chochua S Metcalf BJ Fleming-Dutra KE Nanduri SA Beall B. Continued increase of erythromycin nonsusceptibility and clindamycin nonsusceptibility among invasive group A streptococci driven by genomic clusters, United States, 2018–2019 . Clin Infect Dis . 2023 Feb ; 76 ( 3 ): e1266 – e1269 . https://doi.org/10.1093/cid/ciac468 Search in Google Scholar

Imöhl M, Reinert RR, Ocklenburg C, van der Linden M. Epidemiology of invasive Streptococcus pyogenes disease in Germany during 2003–2007. FEMS Immunol Med Microbiol. 2010 Apr;58(3):389–396. https://doi.org/10.1111/j.1574-695X.2010.00652.x Imöhl M Reinert RR Ocklenburg C van der Linden M. Epidemiology of invasive Streptococcus pyogenes disease in Germany during 2003–2007 . FEMS Immunol Med Microbiol . 2010 Apr ; 58 ( 3 ): 389 – 396 . https://doi.org/10.1111/j.1574-695X.2010.00652.x Search in Google Scholar

Meletis G, Soulopoulos Ketikidis AL, Floropoulou N, Tychala A, Kagkalou G, Vasilaki O, Mantzana P, Skoura L, Protonotariou E. Antimicrobial resistance rates of Streptococcus pyogenes in a Greek tertiary care hospital: 6-year data and literature review. New Microbiol. 2023 Feb;46(1):37–42. Meletis G Soulopoulos Ketikidis AL Floropoulou N Tychala A Kagkalou G Vasilaki O Mantzana P Skoura L Protonotariou E. Antimicrobial resistance rates of Streptococcus pyogenes in a Greek tertiary care hospital: 6-year data and literature review . New Microbiol . 2023 Feb ; 46 ( 1 ): 37 – 42 . Search in Google Scholar

Miller SA, Dykes DD, Polesky HF. A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res. 1988 Feb;16(3):1215. https://doi.org/10.1093/nar/16.3.1215 Miller SA Dykes DD Polesky HF. A simple salting out procedure for extracting DNA from human nucleated cells . Nucleic Acids Res . 1988 Feb ; 16 ( 3 ): 1215 . https://doi.org/10.1093/nar/16.3.1215 Search in Google Scholar

Musser JM, Beres SB, Zhu L, Olsen RJ, Vuopio J, Hyyryläinen HL, Gröndahl-Yli-Hannuksela K, Kristinsson KG, Darenberg J, Henriques-Normark B, et al. Reduced in vitro susceptibility of Streptococcus pyogenes to β-lactam antibiotics associated with mutations in the pbp2x gene is geographically widespread. J Clin Microbiol. 2020 Mar;58(4):e01993-19. https://doi.org/10.1128/JCM.01993-19 Musser JM Beres SB Zhu L Olsen RJ Vuopio J Hyyryläinen HL Gröndahl-Yli-Hannuksela K Kristinsson KG Darenberg J Henriques-Normark B Reduced in vitro susceptibility of Streptococcus pyogenes to β-lactam antibiotics associated with mutations in the pbp2x gene is geographically widespread . J Clin Microbiol . 2020 Mar ; 58 ( 4 ): e01993 - 19 . https://doi.org/10.1128/JCM.01993-19 Search in Google Scholar

Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch Orofacial Sci. 2006. 2006;1:9–14. Naing L Winn T Rusli BN. Practical issues in calculating the sample size for prevalence studies . Arch Orofacial Sci. 2006 . 2006 ; 1 : 9 – 14 . Search in Google Scholar

Ünübol N, Caglayan N, Cebeci S, Beşli Y, Sancak B, Uyar NY, Ahrabi SS, Alebouyeh M, Kocagöz T. Antimicrobial resistance and epidemiological patterns of Streptococcus pyogenes in Tür-kiye. J Infect Public Health. 2025 Feb;18(2):102633. https://doi.org/10.1016/j.jiph.2024.102633 Ünübol N Caglayan N Cebeci S Beşli Y Sancak B Uyar NY Ahrabi SS Alebouyeh M Kocagöz T. Antimicrobial resistance and epidemiological patterns of Streptococcus pyogenes in Tür-kiye . J Infect Public Health . 2025 Feb ; 18 ( 2 ): 102633 . https://doi.org/10.1016/j.jiph.2024.102633 Search in Google Scholar

Ramírez de Arellano E, Saavedra-Lozano J, Villalón P, Jové-Blanco A, Grandioso D, Sotelo J, Gamell A, González-López JJ, Cervantes E, Gónzalez MJ et al; Spanish PedGAS-Net/CIBER-INFEC GAS Study Group. Clinical, microbiological, and molecular characterization of pediatric invasive infections by Streptococcus pyogenes in Spain in a context of global outbreak. mSphere. 2024 Mar;9(3):e0072923. https://doi.org/10.1128/msphere.00729-23 Ramírez de Arellano E Saavedra-Lozano J Villalón P Jové-Blanco A Grandioso D Sotelo J Gamell A González-López JJ Cervantes E Gónzalez MJ Spanish PedGAS-Net/CIBER-INFEC GAS Study Group Clinical, microbiological, and molecular characterization of pediatric invasive infections by Streptococcus pyogenes in Spain in a context of global outbreak . mSphere . 2024 Mar ; 9 ( 3 ): e0072923 . https://doi.org/10.1128/msphere.00729-23 Search in Google Scholar

Rizwan M, Bakht J, Bacha N, Ahmad B. In vitro activity of antimicrobial agents against Streptococcus pyogenes isolated from different regions of Khyber Pakhtun Khwa Pakistan. Pak J Pharm Sci. 2016 Jan;29(1):59–64. Rizwan M Bakht J Bacha N Ahmad B. In vitro activity of antimicrobial agents against Streptococcus pyogenes isolated from different regions of Khyber Pakhtun Khwa Pakistan . Pak J Pharm Sci . 2016 Jan ; 29 ( 1 ): 59 – 64 . Search in Google Scholar

Sakata H. Susceptibility and emm type of Streptococcus pyogenes isolated from children with severe infection. J Infect Chemother. 2013 Dec;19(6):1042–1046. https://doi.org/10.1007/s10156-013-0617-6 Sakata H. Susceptibility and emm type of Streptococcus pyogenes isolated from children with severe infection . J Infect Chemother . 2013 Dec ; 19 ( 6 ): 1042 – 1046 . https://doi.org/10.1007/s10156-013-0617-6 Search in Google Scholar

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gül-mezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323-33. https://doi.org/10.1016/S2214-109X(14)70227-X Say L Chou D Gemmill A Tunçalp Ö Moller AB Daniels J Gül-mezoglu AM Temmerman M Alkema L. Global causes of maternal death: a WHO systematic analysis . Lancet Glob Health . 2014 Jun ; 2 ( 6 ): e323 - 33 . https://doi.org/10.1016/S2214-109X(14)70227-X Search in Google Scholar

Shah NM, Charani E, Ming D, Cheah FC, Johnson MR. Antimicrobial stewardship and targeted therapies in the changing landscape of maternal sepsis. J Intensive Med. 2023 Sep;4(1):46–61. https://doi.org/10.1016/j.jointm.2023.07.006 Shah NM Charani E Ming D Cheah FC Johnson MR. Antimicrobial stewardship and targeted therapies in the changing landscape of maternal sepsis . J Intensive Med . 2023 Sep ; 4 ( 1 ): 46 – 61 . https://doi.org/10.1016/j.jointm.2023.07.006 Search in Google Scholar

Sherwood E, Vergnano S, Kakuchi I, Bruce MG, Chaurasia S, David S, Dramowski A, Georges S, Guy R, Lamagni T, et al. Invasive group A streptococcal disease in pregnant women and young children: A systematic review and meta-analysis. Lancet Infect Dis. 2022 Jul;22(7):1076–1088. https://doi.org/10.1016/S1473-3099(21)00672-1 Sherwood E Vergnano S Kakuchi I Bruce MG Chaurasia S David S Dramowski A Georges S Guy R Lamagni T Invasive group A streptococcal disease in pregnant women and young children: A systematic review and meta-analysis . Lancet Infect Dis . 2022 Jul ; 22 ( 7 ): 1076 – 1088 . https://doi.org/10.1016/S1473-3099(21)00672-1 Search in Google Scholar

Sokou R, Filippatos F, Daniil V, Bikouli ED, Tsantes AG, Pio-vani D, Bonovas S, Iliodromiti Z, Boutsikou T, Tsantes AE, et al. Group A Streptococcus infection in neonatal population: A systematic review of the literature. J Clin Med. 2023 Nov;12(22):6974. https://doi.org/10.3390/jcm12226974 Sokou R Filippatos F Daniil V Bikouli ED Tsantes AG Pio-vani D Bonovas S Iliodromiti Z Boutsikou T Tsantes AE Group A Streptococcus infection in neonatal population: A systematic review of the literature . J Clin Med . 2023 Nov ; 12 ( 22 ): 6974 . https://doi.org/10.3390/jcm12226974 Search in Google Scholar

Song M, Huang X, Hou Y, Yang F, Li X, Li J. Perinatal group A streptococcal infection in vagina and its impact on pregnancy outcomes. Am J Transl Res. 2024 May 15;16(5):1806–1814. https://doi.org/10.62347/ZKIE2772 Song M Huang X Hou Y Yang F Li X Li J. Perinatal group A streptococcal infection in vagina and its impact on pregnancy outcomes . Am J Transl Res . 2024 May 15 ; 16 ( 5 ): 1806 – 1814 . https://doi.org/10.62347/ZKIE2772 Search in Google Scholar

Vannice KS, Ricaldi J, Nanduri S, Fang FC, Lynch JB, Bryson-Cahn C, Wright T, Duchin J, Kay M, Chochua S, et al. Streptococcus pyogenes pbp2x mutation confers reduced susceptibility to β-lactam antibiotics. Clin Infect Dis. 2020 Jun;71(1):201–204. https://doi.org/10.1093/cid/ciz1000 Vannice KS Ricaldi J Nanduri S Fang FC Lynch JB Bryson-Cahn C Wright T Duchin J Kay M Chochua S Streptococcus pyogenes pbp2x mutation confers reduced susceptibility to β-lactam antibiotics . Clin Infect Dis . 2020 Jun ; 71 ( 1 ): 201 – 204 . https://doi.org/10.1093/cid/ciz1000 Search in Google Scholar

Villalón P, Bárcena M, Medina-Pascual MJ, Garrido N, Pino-Rosa S, Carrasco G, Valdezate S. National surveillance of tetracycline, erythromycin, and clindamycin resistance in invasive Streptococcus pyogenes: A retrospective study of the situation in Spain, 2007–2020. Antibiotics. 2023 Jan;12(1):99. https://doi.org/10.3390/antibiotics12010099 Villalón P Bárcena M Medina-Pascual MJ Garrido N Pino-Rosa S Carrasco G Valdezate S. National surveillance of tetracycline, erythromycin, and clindamycin resistance in invasive Streptococcus pyogenes: A retrospective study of the situation in Spain, 2007–2020 . Antibiotics . 2023 Jan ; 12 ( 1 ): 99 . https://doi.org/10.3390/antibiotics12010099 Search in Google Scholar

Weerasekara M, Vidanapathirana G, Li C, Tennegedara A, Dis-sanayake R, Ekanayake A, Abeykoon M, Kothalawala M, Li-yanapathirana V, Ip M. Characterization of group A streptococci causing invasive diseases in Sri Lanka. Access Microbiol. 2024 Jun;6(6):000697.v4. https://doi.org/10.1099/acmi.0.000697.v4 Weerasekara M Vidanapathirana G Li C Tennegedara A Dis-sanayake R Ekanayake A Abeykoon M Kothalawala M Li-yanapathirana V Ip M. Characterization of group A streptococci causing invasive diseases in Sri Lanka . Access Microbiol . 2024 Jun ; 6 ( 6 ): 000697 . v4 . https://doi.org/10.1099/acmi.0.000697.v4 Search in Google Scholar

Wynn JL, Wong HR. Pathophysiology and treatment of septic shock in neonates. Clin Perinatol. 2010;37(2):439–479. https://doi.org/10.1016/j.clp.2010.04.002 Wynn JL Wong HR. Pathophysiology and treatment of septic shock in neonates . Clin Perinatol . 2010 ; 37 ( 2 ): 439 – 479 . https://doi.org/10.1016/j.clp.2010.04.002 Search in Google Scholar

Xiang C, Zhang J, Zhao F, You Y. Emm type distribution of group A Streptococcus in China during 1990 and 2020: A systematic review and implications for vaccine coverage. Front Public Health. 2023 May;11:1157289. https://doi.org/10.3389/fpubh.2023.1157289 Xiang C Zhang J Zhao F You Y. Emm type distribution of group A Streptococcus in China during 1990 and 2020: A systematic review and implications for vaccine coverage . Front Public Health . 2023 May ; 11 : 1157289 . https://doi.org/10.3389/fpubh.2023.1157289 Search in Google Scholar

Yu D, Liang Y, Lu Q, Meng Q, Wang W, Huang L, Bao Y, Zhao R, Chen Y, Zheng Y, et al. Molecular characteristics of Streptococcus pyogenes isolated from Chinese children with different diseases. Front Microbiol. 2021 Dec;12:722225. https://doi.org/10.3389/fmicb.2021.722225 Yu D Liang Y Lu Q Meng Q Wang W Huang L Bao Y Zhao R Chen Y Zheng Y Molecular characteristics of Streptococcus pyogenes isolated from Chinese children with different diseases . Front Microbiol . 2021 Dec ; 12 : 722225 . https://doi.org/10.3389/fmicb.2021.722225 Search in Google Scholar

Zachariadou L, Stathi A, Tassios PT, Pangalis A, Legakis NJ, Pa-paparaskevas J; Hellenic Strep-Euro Study Group. Differences in epidemiology between paediatric and adult invasive Streptococcus pyogenes infections. Epidemiol Infect. 2014 Mar;142(3):512–519. https://doi.org/10.1017/S0950268813001386 Zachariadou L Stathi A Tassios PT Pangalis A Legakis NJ Pa-paparaskevas J Hellenic Strep-Euro Study Group Differences in epidemiology between paediatric and adult invasive Streptococcus pyogenes infections . Epidemiol Infect . 2014 Mar ; 142 ( 3 ): 512 – 519 . https://doi.org/10.1017/S0950268813001386 Search in Google Scholar

Zafar A, Hasan R, Nizamuddin S, Mahmood N, Mukhtar S, Ali F, Morrissey I, Barker K, Torumkuney D. Antibiotic susceptibility in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in Pakistan: A review of results from the Survey of Antibiotic Resistance (SOAR) 2002–15. J Antimicrob Chemother. 2016 May;71(Suppl_1):i103-9. https://doi.org/10.1093/jac/dkw076 Zafar A Hasan R Nizamuddin S Mahmood N Mukhtar S Ali F Morrissey I Barker K Torumkuney D. Antibiotic susceptibility in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in Pakistan: A review of results from the Survey of Antibiotic Resistance (SOAR) 2002–15 . J Antimicrob Chemother . 2016 May ; 71 ( Suppl_1 ): i103 - 9 . https://doi.org/10.1093/jac/dkw076 Search in Google Scholar

Zafar M, Ullah I, Tirmizi S, Yousuf M, Anwar Z, Raza H. Prevalence of group A beta hemolytic Streptococcus related pharyngitis in Pakistan. Pak J Med Health Sci. 2022;16(07):334. https://doi.org/10.53350/pjmhs22167334 Zafar M Ullah I Tirmizi S Yousuf M Anwar Z Raza H. Prevalence of group A beta hemolytic Streptococcus related pharyngitis in Pakistan . Pak J Med Health Sci . 2022 ; 16 ( 07 ): 334 . https://doi.org/10.53350/pjmhs22167334 Search in Google Scholar