{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:54:09Z","timestamp":1790927649244,"version":"4.1.0"},"reference-count":53,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Non\u2010typeable\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      (NT\u2010Sp) strains lack detectable capsules and are often missed by traditional serotyping. While associated primarily with asymptomatic carriage, NT\u2010Sp has emerged as a key player in antimicrobial resistance (AMR) gene dissemination and serotype replacement in the post\u2010vaccine era. This systematic review and meta\u2010analysis synthesize global evidence on NT\u2010Sp carriage, its prevalence, antimicrobial resistance patterns, and genetic diversity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of PubMed, Scopus, Web of Science, Google Scholar, and ScienceDirect was conducted up to May 2025. Eligible studies reporting NT\u2010Sp carriage, molecular typing, or AMR profiles were included. Data extraction and quality assessment followed PRISMA guidelines. A meta\u2010analysis was performed to estimate pooled prevalence of NT\u2010Sp carriage and resistance, with subgroup and meta\u2010regression analyses exploring heterogeneity. Methodological quality was assessed using the Newcastle\u2013Ottawa Scale adapted for cross\u2010sectional studies. Only open\u2010access and free full\u2010text articles were included, which may have introduced selection bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty studies from 23 countries were included. The pooled NT\u2010Sp carriage prevalence was 4.64% (95% CI: 2.78%\u20136.92%), with substantial heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200997.1%, 95% CI: 96.6%\u201397.5%). Subgroup analyses revealed geographic variation, with Oceania showing the highest prevalence (7.24%, 95% CI: 1.39%\u201317.04%) and North America the lowest (0.44%, 95% CI: 0.05%\u20131.11%). Age\u2010stratified analysis showed that studies, including all ages had the highest estimate (29.88%, 95% CI: 0.00%\u2013100.00%), while children had a pooled prevalence of 4.05% (95% CI: 0.00%\u201315.80%). Vaccination era did not significantly influence NT\u2010Sp carriage (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.312). Resistance was highest for co\u2010trimoxazole (67.21%, 95% CI: 49.92%\u201382.73%), penicillin (44.57%, 95% CI: 24.45%\u201365.50%), and erythromycin (39.85%, 95% CI: 19.58%\u201361.77%). Meta\u2010regression identified the \u201call ages\u201d participant category as a significant predictor of lower NT\u2010Sp prevalence (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034). Molecular tools revealed substantial genomic diversity, with dominant clonal complexes varying by region.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>NT\u2010Sp is a globally distributed and genetically diverse pneumococcal subset with considerable AMR potential. Its persistence post\u2010PCV introduction and resistance gene carriage highlights the need for improved detection, molecular surveillance, and consideration in next\u2010generation vaccine development. Specifically, clinical laboratories in high\u2010prevalence settings should adopt molecular methods (e.g., PCR or WGS) to detect NT\u2010Sp in carriage surveillance; empirical antibiotic guidelines for pediatric respiratory infections should consider NT\u2010Sp resistance patterns, particularly the high prevalence of co\u2010trimoxazole resistance (67%) and next\u2010generation PCV trials should include NT\u2010Sp carriage as an exploratory endpoint. Integrating NT\u2010Sp into global pneumococcal control strategies is essential.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.72890","type":"journal-article","created":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T06:22:37Z","timestamp":1785046957000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence, Antimicrobial Resistance, and Genetic Diversity of Non\u2010Typeable\n                    <i>Streptococcus pneumoniae<\/i>\n                    Carriage: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4054-6034","authenticated-orcid":false,"given":"Robert K.","family":"Reeks","sequence":"first","affiliation":[{"name":"Department of Medical Biochemistry University of Ghana Medical School  Accra Greater Accra Region Ghana"},{"name":"Department of Medical Laboratory Technology Accra Technical University  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