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Robert C. Moellering, Barbara E. Murray, Stephen C. Schoenbaum, Jonathan Adler, Christine B. Wennersten, A Novel Mechanism of Resistance to Penicillin-Gentamicin Synergism in Streptococcus faecalis, The Journal of Infectious Diseases, Volume 141, Issue 1, January 1980, Pages 81–86, https://doi.org/10.1093/infdis/141.1.81
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Abstract
A patient with enterococcal endocarditis, who relapsed after repeated courses of apparently adequate treatment with ampicillin plus gentamicin, was subsequently cured with ampicillin-tobramycin therapy. The organisms isolated from this patient were strains of Streptococcus faecalis that were resistant to penicillin (or ampicillin)-gentamicin synergism but not to penicillin (or ampicillin)-tobramycin synergism. The mechanism of resistance in these strains appears to be related to a specific defect in the intracellular uptake of gentamicin (but not tobramycin) in the presence of penicillin.