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Among Selleck SRT1720 the 340 STSS cases recorded, the majority was associated with NF (36.5%). The fatality rate among those STSS cases was 44.9%, a value consistent with the 43% reported in 2007 [2]. emm1 was the most prevalent emm type, which is in accordance with results from the USA, Japan and across Europe, followed by emm28 and emm89 [25�C27]. However, we observed that emm1 decreased since 2006, to be replaced by emm28, emm89 and emm3 types (Fig.?2a). In 2010, emm1 represented only 13.2% of the strains compared with 24.9% and 13.6% for emm28 and emm89, respectively. Fluctuations of emm types have been observed in other European countries and they may reflect ongoing epidemic waves, herd immunity or population immunity [20,27]. As observed in previous surveys, emm1 was associated with NF and emm28 with puerperal infections [20]. Additionally, this study highlights a correlation between emm28 and erysipelas. Therefore, the fluctuation observed for emm1 and emm28 is likely to be due to a combination of several factors over the 5-year period: the increase of gynaeco-obstetrical sepsis from 4.9 to 9.8%, the increase of erysipelas from 8.2 to 13.6%, and the decrease of NF from 25.7 to 19.2%. As already reported, speA was detected in almost all emm1 (98%) and emm3 (99%) types and less frequently among other emm types. speC Fluorouracil purchase was detected in more than 90% of emm2, emm4, emm6, emm11 and emm28. The ssa gene was detected in more than 70% of emm3, emm4, emm22 and emm87. Nevertheless, most of the strains within a given emm type shared the same SA gene profile, which is that found in other countries [27,28]. The relevance of SA genes relating to invasive infections remains controversial as they are present at the same rate in non-invasive isolates [23]. Up to now, GAS remained universally susceptible to ��-lactams and glycopeptides. All strains tested were UNC2881 susceptible to penicillin, amoxicillin and vancomycin, whereas resistances were observed for macrolides and tetracycline. The increase of macrolide and lincosamide resistance rates among GAS observed in many countries constitutes a major concern because these antibiotics are recommended for the treatment of GAS infections in penicillin-allergic patients and in case of STSS. In France, a marked increase was observed in 2004 with a rate reaching 35% [10,29]. In this study, we show that since 2006, erythromycin resistance decreased significantly from 10.9 to 5% (p?
