Macrolide-resistance genes in clinical isolates of Streptococcus pyogenes. 
Macrolide-resistance genes were investigated in 103 macrolide-resistant strains of Streptococcus pyogenes, isolated from children with pharyngotonsillitis.  The presence of mef(A), erm(B), and erm(TR) genes was detected by PCR.  mef(A) was found in 48 out of 103 (46.6%) strains, whereas erm(B) was detected in 43 isolates (41.7%).  All mef(A) strains showed a typical M phenotype (resistance to 14- and 15-membered macrolides, and sensitivity to lincosamides and streptogramin B), whereas erm(B) strains had the MLSB phenotype (resistance to macrolides, lincosamides, and streptogramin B antibiotics).  erm(TR) was found in 10 strains, always together with other resistance genes.  In seven cases erm(TR) was associated with erm(B), and three cases with mef(A).  In two isolates with the M phenotype (1.9%), it was not possible to detect the presence of any of the three macrolide resistance genes tested.  Inducible resistance to macrolides was shown for 24 out of the 53 MLSB strains.  Analysis of macrorestriction fragment patterns by pulsed-field gel electrophoresis showed that erythromycin-resistant S. pyogenes are polyclonal, however each phenotype, MLSB and M, formed essentially homogeneous groups.