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Differences in the DNA Sequences in the Upstream Attenuator Region of erm(A) in Clinical Isolates of Streptococcus pyogenes and Their Correlation with Macrolide/Lincosamide Resistance

ABSTRACT The regulatory regions of 52 erm(A) [formerly erm(TR)] clinical Streptococcus pyogenes isolates were studied. Differences in the upstream regulatory region of erm(A) correlated with macrolide/lincosamide resistance patterns. Nine macrolide/lincosamide/streptogramin B-resistant isolates had changes in the leader sequence of erm(A) including base changes, insertions, or deletions. Isolates were also emm typed.