A clinical isolate of Streptococcus pneumoniae (SP#5) that showed decreased susceptibility to evernimicin (MIC, 1.5 g/ml) was investigated. A 4,255-bp EcoRI fragment cloned from SP#5 was identified by its ability to transform evernimicin-susceptible S. pneumoniae R6 (MIC, 0.03 g/ml) such that the evernimicin MIC was 1.5 g/ml. Nucleotide sequence analysis of this fragment revealed that it contained portions of the S10-spc ribosomal protein operons. The nucleotide sequences of resistant and susceptible isolates were compared, and a point mutation (thymine to guanine) that causes an Ile52-Ser substitution in ribosomal protein L16 was identified. The role of this mutation in decreasing susceptibility to evernimicin was confirmed by direct transformation of the altered L16 gene. The presence of the L16 mutation in the resistant strain suggests that evernimicin is an inhibitor of protein synthesis. This was confirmed by inhibition studies using radiolabeled substrates, which showed that the addition of evernimicin at sub-MIC levels resulted in a rapid decrease in the incorporation of radiolabeled isoleucine in a susceptible isolate (SP#3) but was much less effective against SP#5. The incorporation of isoleucine showed a linear response to the dose level of evernimicin. The incorporation of other classes of labeled substrates was unaffected or much delayed, indicating that these were secondary effects.Everninomicins are a class of oligosaccharide antibiotics isolated from Micromonospora carbonaceae (31). One such compound, evernimicin (SCH 27899) (10, 11, 12) is currently undergoing evaluation as a therapeutic agent. It has been shown to have potent activity against many gram-positive bacteria, including emerging problem organisms such as vancomycinresistant enterococci, methicillin-resistant staphylococci, and penicillin-resistant pneumococci (16). In fact, there were no staphylococcal, enterococcal, and pneumococcal isolates that displayed resistance to evernimicin in either the investigation by Jones and Barrett (16) or a more-recent worldwide survey of clinical isolates, including isolates known to be resistant to other antibiotics (R. S. Hare, F. J. Sabatelli, and the Ziracin Susceptibility Testing Group, Abstr. 38th Intersci. Conf. Antimicrob. Agents Chemother., abstr. E-119, p. 204, 1998). The paucity of isolates showing resistance to evernimicin is presumably a result of no prior clinical exposure to a drug similar to the family of everninomicins. The lack of cross-resistance to evernimicin, however, would suggest that the mechanism of action is novel and that prior selection leading to resistance to other antimicrobials will not impact the efficacy of evernimicin.Previous studies with another oligosaccharide antibiotic, avilamycin (33), showed protein synthesis inhibition as the mechanism of action, apparently by interacting with the 30S ribosomal subunit. Nevertheless, avilamycin lacks the nitrosugar moiety that distinguishes the everninomicin class of antibiotics, and the mechanism of action of everninomicin...