title: Beta-hemolytic streptococcal infections in trauma patients.
abstract: OBJECTIVE
  β-hemolytic streptococci (βHS) causes a diverse array of human infections. The molecular epidemiology of β-hemolytic streptococcal infections in trauma patients has not been studied. This study reports the molecular and clinical epidemiology of β-hemolytic streptococcal infections at a level 1 trauma centre of India.
  
  
  METHODS
  A total of 117 isolates of βHS were recovered from clinical samples of trauma patients. The isolates were identified to species level and subjected to antimicrobial susceptibility testing. Polymerase chain reaction (PCR) assay was done to detect exotoxin virulence genes. The M protein gene (emm gene) types of GAS strains were ascertained by sequencing.
  
  
  RESULTS
  Group A Streptococcus (GAS) was the most common isolate (64 %), followed by group G Streptococcus (23 %). A large proportion of GAS produced speB (99 %), smeZ (91 %), speF (95 %) and speG (87 %). smeZ was produced by 22 % of GGS. A total of 25 different emm types/subtypes were seen in GAS, with emm 11 being the most common. Resistance to tetracycline (69 %) and erythromycin (33 %) was commonly seen in GAS.
  
  
  CONCLUSIONS
  β-hemolytic streptococcal infections in Indian trauma patients are caused by GAS and non-GAS strains alike. A high diversity of emm types was seen in GAS isolates, with high macrolide and tetracycline resistance. SpeA was less commonly seen in Indian GAS isolates. There was no association between disease severity and exotoxin gene production.
authors.affiliation: Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India. purvamathur@yahoo.co.in.
authors.forename: P
authors.initials: P
authors.lastname: Mathur
authors.affiliation: Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India. nidhi_paras13@yahoo.co.in.
authors.forename: N
authors.initials: N
authors.lastname: Bhardwaj
authors.affiliation: Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India. gunjan1210@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Gupta
authors.affiliation: Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India. puniaparul47@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Punia
authors.affiliation: Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India. vibhor_tak@yahoo.com.
authors.forename: V
authors.initials: V
authors.lastname: Tak
authors.affiliation: Department of Surgery, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India. mcmisra@gmail.com.
authors.forename: M C
authors.initials: MC
authors.lastname: Misra
keywords: Antimicrobial resistance; Group A Streptococcus; Spe emm types; Trauma patients; β-hemolytic streptococci
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