016, two-tailed Fisher’s exact test). Among the invasive macrolide-resistant isolates, 10 (53%) presented the M phenotype and were therefore susceptible to clindamycin, whereas the remaining nine

(47%) were also constitutively resistant to clindamycin (cMLSB phenotype). The proportion of the two phenotypes was similar among the pharyngitis isolates, with 37 isolates (55%) presenting the M phenotype and 30 (45%) presenting the MLSB phenotype (one with Doramapimod chemical structure inducible resistance and the others with constitutive resistance to clindamycin). All the isolates presenting the M phenotype of macrolide resistance carried only the mef(A) variant of the mef determinant. The cMLSB isolates carried only the erm(B) gene, except for one pharyngitis isolate which also harbored mef(A), and the only iMLSB isolate in the collection that presented the erm(A) gene. Table 1 PFGE clusters

presenting antimicrobial resistant isolates collected from selleck kinase inhibitor invasive infections and pharyngitis in Portugal PFGE cluster a Antimicrobial resistance b No. of resistant isolates Invasive Pharyngitis C38 Tet   1 D36 MLSB   1 M   1 G27 M 6 19 M,Tet 1   H26 MLSB,Bac 6 17 Tet   1 I24 MLSB,Tet   1 J16 Tet 12 1 K14 M   1 L13 MLSB,Tet 1 6 Tet 2   M11 MLSB,Tet 1   N10 Tet 1 1 MLSB,Tet   1 O9 M 4 5 R6 M   3 S6 M   1 a Clusters are designated by capital letters and a subscript LBH589 supplier number indicating the number of isolates in each cluster; b The antibiotics tested were penicillin quinupristin/dalfopristin, chloramphenicol, vancomycin, linezolid, levofloxacin, erythromycin, clindamycin, tetracycline, and bacitracin. M, presenting the M phenotype of macrolide resistance; MLSB, presenting the MLSB phenotype of macrolide resistance; Tet, this website non-susceptibility to tetracycline; M,Tet, presenting the M phenotype of macrolide resistance and resistance to tetracycline; MLSB,Tet, presenting the MLSB phenotype of macrolide resistance and resistance to tetracycline;

MLSB,Bac, presenting the MLSB phenotype of macrolide resistance and resistance to bacitracin. In contrast to erythromycin, tetracycline resistance was much lower among the pharyngitis isolates when compared with the invasive group (6% vs 17%, P < 0.001). One invasive isolate presented intermediate resistance to tetracycline (MIC = 3μg/ml). All the resistant strains carried the tet(M) gene, except one pharyngitis isolate for which no PCR product was obtained for any of the screened tetracycline-resistance genes. The tet(L) gene was detected in only one pharyngitis isolate, which also harbored tet(M), while the genes tet(K) and tet(O) were not amplified in any of the studied isolates. Overall there was a positive association between the genes tet(M) and erm(B) (P < 0.