ICE in GBS conferring AMR. Genomic analysis reveals new Integrative Conjugal Elements and transposons in GBS conferring antimicrobial resistance

Streptococcus agalactiae or Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and increasingly found as an invasive pathogen in older patient populations. Beta-lactam antibiotics remain the most effective therapeutic with resistance rarely reported, while the majority of GBS isolates carry the tetracycline resistance gene tetM in fixed genomic positions amongst five pre-dominant clonal clades. In the UK GBS resistance to clindamycin and erythromycin has in-creased from 3% in 1991 to 11.9% (clindamycin) and 20.2% (erythromycin) as reported in this study. Here, a systematic investigation of antimicrobial resistance genomic content sought to fully characterise the associated mobile genetic elements within phenotypically resistant GBS isolates from 193 invasive and non-invasive GBS infection of UK adult patients collected during 2014 and 2015