{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:12:39Z","timestamp":1775607159216,"version":"3.50.1"},"reference-count":39,"publisher":"Cambridge University Press (CUP)","issue":"7","license":[{"start":{"date-parts":[[2007,8,16]],"date-time":"2007-08-16T00:00:00Z","timestamp":1187222400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2008,7]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>Antimicrobial resistance of pneumococci is influenced by serotypes, antimicrobial consumption and vaccine use. Serotyping of 697 out of 1331 pneumococcal isolates, recovered in Portugal from 1994 to 2004, showed that the theoretical rate of heptavalent conjugate vaccine coverage was 91\u00b77% and 63\u00b76% for penicillin and erythromycin non-susceptible strains, respectively, in children up to 1 year old. The use of amoxicillin and erythromycin decreased in the vaccine period 2001\u20132004 (<jats:italic>P<\/jats:italic>=0\u00b704 and<jats:italic>P<\/jats:italic>&lt;0\u00b701, respectively) but azithromycin usage increased in the same period (<jats:italic>P<\/jats:italic>&lt;0\u00b701). By using linear regression models, we evaluated the role of antimicrobial and vaccine use in the trends of resistance to penicillin and erythromycin among the isolates. The models suggest that the use of macrolides was the main factor associated with an increase of penicillin and erythromycin non-susceptible isolates from adults (<jats:italic>P<\/jats:italic>&lt;0\u00b701) and erythromycin non-susceptible isolates among children (<jats:italic>P<\/jats:italic>=0\u00b7006). These models also suggest that heptavalent vaccine is failing to reduce antimicrobial resistance as expected, possibly due to the increased consumption of azithromycin (<jats:italic>P<\/jats:italic>=0\u00b704). The efficient use of new antibiotics may reverse the present trends of antimicrobial resistance.<\/jats:p>","DOI":"10.1017\/s0950268807009405","type":"journal-article","created":{"date-parts":[[2007,8,16]],"date-time":"2007-08-16T08:00:02Z","timestamp":1187251202000},"page":"928-939","source":"Crossref","is-referenced-by-count":15,"title":["Trends in resistance to penicillin and erythromycin of invasive pneumococci in Portugal"],"prefix":"10.1017","volume":"136","author":[{"given":"R.","family":"DIAS","sequence":"first","affiliation":[]},{"given":"M.","family":"CANI\u00c7A","sequence":"additional","affiliation":[]}],"member":"56","published-online":{"date-parts":[[2007,8,16]]},"reference":[{"key":"S0950268807009405_ref037","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.8.3520-3522.2005"},{"key":"S0950268807009405_ref039","doi-asserted-by":"publisher","DOI":"10.2174\/1568005043340641"},{"key":"S0950268807009405_ref030","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.6.2206-2213.2004"},{"key":"S0950268807009405_ref010","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1128\/JCM.35.3.764-766.1997","article-title":"Dot blot assay for the serotyping of pneumococci","volume":"35","author":"Fenoll","year":"1997","journal-title":"Journal of Clinical Microbiology"},{"key":"S0950268807009405_ref006","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00198-06"},{"key":"S0950268807009405_ref036","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkh178"},{"key":"S0950268807009405_ref034","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkf175"},{"key":"S0950268807009405_ref032","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)04972-2"},{"key":"S0950268807009405_ref018","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkf507"},{"key":"S0950268807009405_ref027","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.94.12.6571"},{"key":"S0950268807009405_ref020","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkf504"},{"key":"S0950268807009405_ref008","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022823"},{"key":"S0950268807009405_ref033","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmm.2004.04.004"},{"key":"S0950268807009405_ref019","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.313.7054.387"},{"key":"S0950268807009405_ref015","first-page":"49","article-title":"Acceptance of the new conjugate vaccines. Meningococcal and pneumococcal vaccines, in the cohort born in 1999, in the North Region of Portugal","volume":"17","author":"De Queir\u00f3s","year":"2004","journal-title":"Acta M\u00e9dica Portuguesa"},{"key":"S0950268807009405_ref001","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkf500"},{"key":"S0950268807009405_ref017","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/48.4.463"},{"key":"S0950268807009405_ref028","doi-asserted-by":"publisher","DOI":"10.1097\/00006454-200110000-00008"},{"key":"S0950268807009405_ref007","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkh469"},{"key":"S0950268807009405_ref024","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-001-1072-3"},{"key":"S0950268807009405_ref005","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkh458"},{"key":"S0950268807009405_ref021","doi-asserted-by":"publisher","DOI":"10.3201\/eid1106.050198"},{"key":"S0950268807009405_ref014","first-page":"373","article-title":"Meningococcal and pneumococcal conjugate vaccines. Recommendations of the Pediatric Infectiology from the Portuguese Pediatric Society","volume":"34","year":"2003","journal-title":"Acta Pedi\u00e1trica Portuguesa"},{"key":"S0950268807009405_ref022","doi-asserted-by":"publisher","DOI":"10.3201\/eid0803.010192"},{"key":"S0950268807009405_ref029","doi-asserted-by":"publisher","DOI":"10.1097\/01.inf.0000154326.77617.3e"},{"key":"S0950268807009405_ref025","doi-asserted-by":"publisher","DOI":"10.1086\/318160"},{"key":"S0950268807009405_ref003","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0691.8.s.2.5.x"},{"key":"S0950268807009405_ref013","doi-asserted-by":"publisher","DOI":"10.1002\/0471725153"},{"key":"S0950268807009405_ref012","first-page":"315","article-title":"Antimicrobial use in the community: a surveillance study from M\u00e9dicos-Sentinela","volume":"19","author":"Falc\u00e3o","year":"2003","journal-title":"Revista Portuguesa de Cl\u00ednica Geral"},{"key":"S0950268807009405_ref026","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00153-06"},{"key":"S0950268807009405_ref038","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkg078"},{"key":"S0950268807009405_ref011","unstructured":"11.\u00a0World Health Organization. The anatomical therapeutic chemical classification system with defined daily doses (ATC\/DDD). 2005 (http:\/\/www.whocc.no\/atcddd\/indexdatabase\/). Accessed 22 March 2005."},{"key":"S0950268807009405_ref002","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/3.2.246"},{"key":"S0950268807009405_ref035","unstructured":"35.\u00a0WHO. Antimicrobial and support therapy for bacterial meningitis in children. Report of the meeting of 18\u201320. June 1997, Geneva, Switzerland, 1998 (http:\/\/www.who.int\/entity\/csr\/resources\/publications\/meningitis\/whoemcbac982.pdf). 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