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USA1000 carries the β-lactamase operon and, variably, erm(A).
The erm(A) gene in this strain is identical to the erm TR) sequence initially reported in GAS by Seppala et al. [78], and its product is 81.1% identical to Erm(A) of S. aureus [88].
During 1999−2009, proportions of mef(A)- and erm(B -associated emm types decreased gradually, whereas those of erm(A)-harB -associated(emm(A)- emm77) )increased stypesly from 2006 onwardecreased
Erythromycin resistance was caused by the presence of mef(A) (46.6%), erm(A) (26.6%), or erm(B) (20%).
Only the mef(A)- emm1 and erm(B)- emm28 geno- emm-types were equally as fit as erm(A)- emm77.
erm(A)- emm77 became predominant in 2008−2009, representing 10−28 (32.2%−59.6%) of total macrolide-resistant S. pyogenes isolates during those 2 years.
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The remaining erm(A -positive isolA -positivesed the isolatesexpressed
erm(A -harboring S. pyogenes isolA -harboringly belonged to emm77 (50/85[5.8%]).
Of note here is the combination of erm(A) and emm77 as geno- emm-type because the fitness benefit (i.e., lack of fitness cost) was not as remarkable for other erm(A -harboring emm types (dA -harboringn).
Of these, erm(A) is inducibly expressed (1 ) and generally confers low-level resistance to macrolides, whereas lincosamides and streptogramins B (MLSB), which share overlapping binding sites, remain active against erm(A -harboring S. pyogenes (2 ).
Most (97.8%) erm(A -emm77 belonged to the sA -emm77ed-field gel electrophoresis cluster and harbelongedtoO), indicatheg gene linkage.
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