C. Silva-Costa, F.R. Pinto, M. Ramirez, J. Melo-Cristino

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Decrease in macrolide resistance and clonal instability among Streptococcus pyogenes in Portugal C. Silva-Costa, F.R. Pinto, M. Ramirez, J. Melo-Cristino Clinical Microbiology and Infection Volume 14, Issue 12, Pages 1152-1159 (December 2008) DOI: 10.1111/j.1469-0691.2008.02104.x Copyright © 2008 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 1 Erythromycin resistance and prevalence of macrolide resistance phenotypes in Portugal during the period 1998–2006. Open circles and solid lines represent the proportion of erythromycin-resistant group A streptococci among those causing pharyngitis and corresponding 95% CIs. Broken lines represent the proportion of each phenotype in the population. Solid triangles represent the proportion of isolates of the M phenotype. Open triangles represent the proportion of isolates of the MLSB phenotype. Clinical Microbiology and Infection 2008 14, 1152-1159DOI: (10.1111/j.1469-0691.2008.02104.x) Copyright © 2008 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 2 Pulsed-field gel electrophoresis (PFGE) analysis of macrolide-resistant Streptococcus pyogenes isolates from Portugal. (a) Dendrogram showing cluster analysis of the PFGE profiles of the 156 macrolide-resistant isolates by the unweighted pair-group with arithmetic mean (UPGMA) method. Dice coefficients (percentages) are indicated in the scale above the dendrogram. For each of the major clones, a triangle proportional to the number of isolates is shown in the dendrogram, followed by the capital letter designating the PFGE cluster. (b) PFGE profiles generated following SmaI (MLSB isolates) or Cfr9I (M isolates) digestion of DNA isolated from representatives of each major clone. Capital letters identifying each lane correspond to the clone designations. m, lambda ladder PFGE marker (New England Biolabs, Beverly, MA, USA). Clinical Microbiology and Infection 2008 14, 1152-1159DOI: (10.1111/j.1469-0691.2008.02104.x) Copyright © 2008 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 3 Simpson's index of diversity for the population of macrolide-resistant group A streptococcus (1998–2006). Simpson's index of diversity and corresponding 95% CIs were calculated for the PFGE clusters of macrolide-resistant Streptococcus pyogenes isolates from each study year. Clinical Microbiology and Infection 2008 14, 1152-1159DOI: (10.1111/j.1469-0691.2008.02104.x) Copyright © 2008 European Society of Clinical Infectious Diseases Terms and Conditions