{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:25:17Z","timestamp":1777922717289,"version":"3.51.4"},"reference-count":57,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T00:00:00Z","timestamp":1427846400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:p>\n                    Pneumococcal macrolide resistance is usually expressed as one of two phenotypes: the M phenotype conferred by the\n                    <jats:italic toggle=\"yes\">mef<\/jats:italic>\n                    gene or the MLS\n                    <jats:sub>B<\/jats:sub>\n                    phenotype caused by modification of ribosomal targets, most commonly mediated by an\n                    <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                    methylase. Target-site modification leading to antibiotic resistance can also occur due to sequence mutations within the 23S rRNA or the L4 and L22 riboproteins. We screened 4,535 invasive isolates resistant to erythromycin and 18 invasive isolates nonsusceptible to quinupristin\u2013dalfopristin (Q-D) to deduce the potential mechanisms involved. Of 4,535 erythromycin-resistant isolates, 66.2% were polymerase chain reaction (PCR)-positive for\n                    <jats:italic toggle=\"yes\">mef<\/jats:italic>\n                    alone, 17.8% for\n                    <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                    B alone, and 15.1% for both\n                    <jats:italic toggle=\"yes\">mef<\/jats:italic>\n                    and\n                    <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                    B. Thirty-seven isolates (0.9%) were PCR negative for both determinants. Of these, 3 were positive for\n                    <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                    A (subclass\n                    <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                    TR) and 25 had chromosomal mutations. No chromosomal mutations (in 23S rRNA,\n                    <jats:italic toggle=\"yes\">rpl<\/jats:italic>\n                    D, or\n                    <jats:italic toggle=\"yes\">rpl<\/jats:italic>\n                    V) nor any of the macrolides\/lincosamides\/streptogramin (MLS) resistance genes screened for (\n                    <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                    T,\n                    <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                    A,\n                    <jats:italic toggle=\"yes\">cfr<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">lsa<\/jats:italic>\n                    C, and\n                    <jats:italic toggle=\"yes\">vga<\/jats:italic>\n                    A) were found in the remaining nine isolates. Of 18 Q-D nonsusceptible isolates, 14 had chromosomal mutations and one carried both\n                    <jats:italic toggle=\"yes\">mef<\/jats:italic>\n                    and\n                    <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                    B; no chromosomal mutations or other resistance genes were found in 3 isolates. Overall, we found 28 mutations, 13 of which have not been previously described in\n                    <jats:italic toggle=\"yes\">Streptococcus pneumoniae<\/jats:italic>\n                    . The role of these mutations remains to be confirmed by transformation assays.\n                  <\/jats:p>","DOI":"10.1089\/mdr.2014.0086","type":"journal-article","created":{"date-parts":[[2014,8,12]],"date-time":"2014-08-12T16:18:16Z","timestamp":1407860296000},"page":"121-129","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":18,"title":["Mobile Elements and Chromosomal Changes Associated with MLS Resistance Phenotypes of Invasive Pneumococci Recovered in the United States"],"prefix":"10.1177","volume":"21","author":[{"given":"Paulina A.","family":"Hawkins","sequence":"first","affiliation":[{"name":"Emory University","place":["Georgia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sopio","family":"Chochua","sequence":"additional","affiliation":[{"name":"Emory University","place":["Georgia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Delois","family":"Jackson","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention","place":["Georgia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernard","family":"Beall","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention","place":["Georgia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lesley","family":"McGee","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention","place":["Georgia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2015,4]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Active Bacterial Core surveillance (ABCs) Centers for Disease Control and Prevention (CDC). 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