Opponents of the avoparcin ban have argued that, in contrast with Europe, there is an increasing prevalence of GREF in Northern America, where avoparcin has never been in use. Infections with GREF require a more complex scenario: immunocompromized patients, selective pressure in favour of enterococci in general by third generation cephalosporins and fluoroquinolones and in favour of GREF by glycopeptides [41]. As shown in Fig. 1 glycopeptides are used in human chemotherapy units to a larger extent in the United States than in Germany [42]. Streptogramin resistance in E. faecium and in particular in GREF of hospital origin observed in Germany and earlier described in the United States [35] and [36] has not been selected by streptogramin use in humans; the origin in animal husbandry is rather likely. As already seen with streptothricin resistance in E. coli, streptogramin resistance genes were obviously disseminated in the absence of direct selective pressure (food chain). The example of virginiamycin also shows that an antibacterial used for animal feeding becomes risky when related compounds are introduced into human chemotherapy.