The presence of a novel macrolide efflux system in streptococci was first described and firmly established in 1996 by Sutcliffe et al. (81). This system was phenotypically recognized and characterized to confer low-level resistance (MICs, 1 to 32 g/ml) to 14and 15-membered macrolides but not to 16membered macrolides, lincosamides, or streptogramin B (or their analogues). This phenotypic pattern...

G A Streptococcus (GAS) is the most common cause of acute bacterial pharyngitis, accounting for 20-30% of episodes of pharyngitis in children and 5-15% in adults.1 Streptococcal pharyngitis is a benign illness; however, it can be associated with suppurative tonsillopharyngeal complications or nonsuppurative immune mediated complications such as acute rheumatic fever (ARF), rheumatic heart disea...

Sir, We wish to comment on the paper by Van Kerkhoven et al.,1 to dispel certain misconceptions that may arise from a cursory review of their study. The authors present a 3 year retrospective chart review of patients hospitalized with pneumococcal bacteraemia at a single hospital. Of the 136 patients identified, 14 (10.3%) and 33 (24.3%) had isolates non-susceptible to penicillin and erythromyc...

Sir, The genes vga(A) and vga(C) and the most recently identified gene, vga(E), as well as the gene cfr, mediate transferable resistance to pleuromutilins in staphylococci. The vga genes encode ABC transporters, which also export streptogramin A antibiotics and lincosamides, and the cfr gene encodes a methyltransferase that confers additional resistance to phenicols, lincosamides, oxazolidinone...