Emergence of multidrug-resistant and -hypervirulent Streptococcus agalactiae in Bulgarian patients

To the Editor, Group B Streptococcus (GBS) (Streptococcus agalactiae) is the leading etiological agent of neonatal meningitis and sepsis but also causes soft-tissue and urogenital infections.1 In streptococcal infections complicated by allergy or poor therapeutic response to penicillin, the first alternative choice is macrolides.1, 2 The rate of macrolide resistance worldwide has increased recently, sometimes in combination with lincosamide resistance in GBS.2 The most common serotype-specific antigens for human GBS isolates are Ia, Ib, II, III, and V.3 A hypervirulent clone of GBS serotype III that causes invasive disease, pregnancy-associated infections, and urinary tract infections emerged in Hong Kong between 1993-2012.