1321. Increased Prevalence of Group A Streptococcus (GAS) High Level Macrolide Resistance During the COVID-19 Pandemic

Abstract Background COVID-19 affected the epidemiology of many respiratory pathogens including GAS. Assessing genetic heterogeneity (emm type, antimicrobial resistance, virulence factors) can inform treatment recommendations and targets for potential GAS vaccines. We assessed clinical antibiotic susceptibility performed whole genome sequencing (WGS) among pediatric pharyngeal isolates from 2020–2022. Methods From 1/2020–3/2022 we collected throat swabs in clinics EDs children aged 3-18 years Chicago, IL; Atlanta, GA; Portland, OR; Phoenix, AZ: 1) with acute pharyngitis 2) a convenience sample asymptomatic to assess colonization. Swabs were plated on blood agar. E-tests used erythromycin (ERY) ciprofloxacin (CIP). emm type resistance genes (ERY, Clindamycin (CLI), fluoroquinolones) by WGS. Results 1144 collected: 359/684 (52%) rapid test 20/460 (4.3%) yielded culture. Phenotypic resistance: 55/364 (15%) tested ERY resistant 5/364 (1.4%) CIP resistant. The proportion increased significantly 2020 (6%) 2021–2022 (25%) (χ2 = 23.70, p< .00001) (Figure 1). MICs high (Table Genotypic Of 304 sequenced 40/304 (13%) resistant, 35/304 (11.5%) both CLI (inducible or constitutive) 4/304 (1.3%) fluoroquinolone ermB (62%) was most common gene constitutive followed ermTR (23%) ermT (11%) conferring inducible resistance. Among 20 no ERY, CLI, occurred, identified. types 11, 9, 77, 58 94 associated Conclusion rate erm genes. These results are important vaccine development that reduce antimicrobial-resistant disease. Disclosures All Authors: No reported disclosures.