Cfr modifies the bacterial ribosome at adenine 2503 of 23S rRNA, blocking the binding of multiple antibiotic classes — phenicols, lincosamides, oxazolidinones (including linezolid), pleuromutilins, and streptogramins A (PhLOPSA resistance). Resistance to linezolid is particularly concerning because linezolid is often used for serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).
Detection of cfr in molecular susceptibility testing identifies organisms likely resistant to multiple last-resort antibiotics and informs treatment selection and infection control measures. Sample type is typically a culture isolate or direct clinical specimen.
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