ArticleFrontiers in cellular and infection microbiology2026
Population structure reveals clade- and region-specific dissemination of macrolide-resistant
Article in Frontiers in cellular and infection microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Macrolide-resistant Results: Macrolide resistance was identified in 61.5% (377/613) of strains, and 94.2% of resistant strains carried the A2063G mutation in the 23S rRNA gene. Resistant strains were strongly concentrated in East Asia (70.5% vs 13.4% in non-East Asian regions), with resistance rates varying across countries, ranging from 30.4% in Japan to 99.0% in China. This pattern cannot be fully explained by the expansion of the well-characterized resistant clade T1-3R alone, but is more likely attributable to the emergence of resistance in multiple genetic backgrounds. Notably, in T1-2 and T2-2, resistance rates among East Asian strains were 66.0% and 45.4%, respectively, whereas no resistant strains were identified in non-East Asian populations, highlighting regional disparities within the same clonal backgrounds. Phylogenetic network analysis of these clades further suggested that resistant variants did not arise sporadically but appeared to reflect mutation acquisition followed by regional clonal expansion. In contrast to the geographically restricted expansion of resistant clones, macrolide-susceptible strains from different regions occasionally showed close genetic relatedness within 10 SNPs, suggesting that cross-regional dissemination of Conclusions: These findings suggest that the high prevalence of MRMP in East Asia cannot be explained solely by the expansion of a single resistant lineage. Instead, multiple resistant clones appear to have emerged and expanded within several clades that are prevalent in East Asia. This population-structured view of MRMP dissemination provides a framework for understanding regional differences in resistance dynamics and underscores the importance of continued genome-based surveillance to monitor the emergence and regional spread of resistant clones.
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