{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T12:05:53Z","timestamp":1783253153303,"version":"3.54.6"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,2,18]],"date-time":"2020-02-18T00:00:00Z","timestamp":1581984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 DC008671"],"award-info":[{"award-number":["R01 DC008671"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Antibiotic-resistant Streptococcus pneumoniae strains may cause infections that fail to respond to antimicrobial therapy. Results reported from hospitalized patients with invasive, bacteremic infections may not be the same as those observed in a primary care setting where young children receive care for noninvasive infections. Young children experience the highest burden of pneumococcal disease. The aim of this study was to determine the antibiotic susceptibility of S. pneumoniae strains isolated from children in a primary care setting in the post\u201313-valent pneumococcal conjugate vaccine (PCV13) era.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a prospective collection of 1201 isolates of S. pneumoniae from 2006 through 2016 in a primary care setting. Antibiotic susceptibility testing to 16 different antibiotics of 10 classes was performed. Participants were children aged 6\u201336 months. Nasopharyngeal swabs were obtained from patients during acute otitis media (AOM) visits and routine healthy visits. Middle ear fluid was obtained by tympanocentesis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>After introduction of PCV13, antibiotic susceptibility of pneumococci, especially to penicillin, initially improved largely due to disappearance of serotype 19A, included in PCV13. However, beginning in 2013, antibiotic susceptibility among pneumococcal strains began decreasing due to new serotypes not included in PCV13. In addition to reduced susceptibility to penicillin, the most recent isolates show reduced susceptibility to third-generation cephalosporins, fluoroquinolones, and carbapenems, antibiotics commonly used to treat life-threatening, invasive pneumococcal diseases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In recent years, pneumococcal nasopharyngeal and AOM isolates from children exhibit reduced susceptibility to penicillin, third-generation cephalosporin, fluoroquinolone, and carbapenem antibiotics. The new strains have a different profile of resistance compared to the pre-PCV13 era.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa157","type":"journal-article","created":{"date-parts":[[2020,2,13]],"date-time":"2020-02-13T20:11:07Z","timestamp":1581624667000},"page":"797-805","source":"Crossref","is-referenced-by-count":66,"title":["Rising Pneumococcal Antibiotic Resistance in the Post\u201313-Valent Pneumococcal Conjugate Vaccine Era in Pediatric Isolates From a Primary Care Setting"],"prefix":"10.1093","volume":"72","author":[{"given":"Ravinder","family":"Kaur","sequence":"first","affiliation":[{"name":"Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minh","family":"Pham","sequence":"additional","affiliation":[{"name":"School of Mathematical Sciences, College of Science, Rochester Institute of Technology, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl O A","family":"Yu","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E","family":"Pichichero","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,2,18]]},"reference":[{"key":"2021030519532193500_CIT0001","volume-title":"The immunological basis for immunization series, module 12: pneumococcal vaccines","author":"K\u00e4yhty","year":"2009"},{"key":"2021030519532193500_CIT0002","doi-asserted-by":"crossref","first-page":"2320","DOI":"10.12688\/f1000research.9283.1","article-title":"Epidemiology, virulence factors and management of the pneumococcus","volume":"5","author":"Feldman","year":"2016","journal-title":"F1000Res"},{"key":"2021030519532193500_CIT0003","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/BF02013089","article-title":"World-wide development of antibiotic resistance in pneumococci","volume":"6","author":"Appelbaum","year":"1987","journal-title":"Eur J Clin Microbiol"},{"key":"2021030519532193500_CIT0004","doi-asserted-by":"crossref","first-page":"ii3","DOI":"10.1093\/jac\/dki297","article-title":"The Alexander project: the benefits from a decade of surveillance","volume":"56","author":"Felmingham","year":"2005","journal-title":"J Antimicrobial Chemotherapy"},{"key":"2021030519532193500_CIT0005","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1111\/j.1469-0691.2010.03182.x","article-title":"Changes in antimicrobial resistance, serotypes and genotypes in Streptococcus pneumoniae over a 30-year period","volume":"16","author":"Li\u00f1ares","year":"2010","journal-title":"Clin Microbiol Infect"},{"key":"2021030519532193500_CIT0006","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/INF.0b013e31828d9acc","article-title":"Acute otitis media otopathogens during 2008 to 2010 in Rochester, New York","volume":"32","author":"Casey","year":"2013","journal-title":"Pediatric Infect Dis J"},{"key":"2021030519532193500_CIT0007","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/S1473-3099(08)70281-0","article-title":"Impact of conjugate pneumococcal vaccines on antibiotic resistance","volume":"8","author":"Dagan","year":"2008","journal-title":"Lancet Infect Dis"},{"key":"2021030519532193500_CIT0008","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1128\/CMR.00058-15","article-title":"Biological and epidemiological features of antibiotic-resistant Streptococcus pneumoniae in pre- and post-conjugate vaccine eras: a United States perspective","volume":"29","author":"Kim","year":"2016","journal-title":"Clin Microbiol Rev"},{"key":"2021030519532193500_CIT0009","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1097\/INF.0000000000001206","article-title":"Emerging Streptococcus pneumoniae strains colonizing the nasopharynx in children after 13-valent pneumococcal conjugate vaccination in comparison to the 7-valent era, 2006\u20132015","volume":"35","author":"Kaur","year":"2016","journal-title":"Pediatric Infect Dis J"},{"key":"2021030519532193500_CIT0010","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/S2352-4642(18)30168-8","article-title":"Effectiveness of 13-valent pneumococcal conjugate vaccination for protection against acute otitis media caused by Streptococcus pneumoniae in healthy young children: a prospective observational study","volume":"2","author":"Pichichero","year":"2018","journal-title":"Lancet Child Adolesc Health"},{"key":"2021030519532193500_CIT0011","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1093\/jpids\/piw005","article-title":"The effect of 13-valent pneumococcal conjugate vaccine on the serotype distribution and antibiotic resistance profiles in children with invasive pneumococcal disease","volume":"6","author":"Gaviria-Agudelo","year":"2017","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2021030519532193500_CIT0012","doi-asserted-by":"crossref","first-page":"905","DOI":"10.3201\/eid1506.080684","article-title":"Changes in fluoroquinolone-resistant Streptococcus pneumoniae after 7-valent conjugate vaccination, Spain","volume":"15","author":"de la Campa","year":"2009","journal-title":"Emerging Infect Dis"},{"key":"2021030519532193500_CIT0013","doi-asserted-by":"crossref","DOI":"10.1099\/mgen.0.000252","article-title":"Population genomics of pneumococcal carriage in Massachusetts children following introduction of PCV-13","volume":"5","author":"Mitchell","year":"2019","journal-title":"Microb Genomics"},{"key":"2021030519532193500_CIT0014","volume-title":"Active Bacterial Core surveillance report, Emerging Infections Program network, Streptococcus pneumoniae","author":"Centers for Disease Control and Prevention","year":"2007"},{"key":"2021030519532193500_CIT0015","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1001\/jama.298.15.1772","article-title":"Emergence of a multiresistant serotype 19A pneumococcal strain not included in the 7-valent conjugate vaccine as an otopathogen in children","volume":"298","author":"Pichichero","year":"2007","journal-title":"JAMA"},{"key":"2021030519532193500_CIT0016","doi-asserted-by":"crossref","first-page":"547","DOI":"10.3201\/eid1504.071704","article-title":"Novel type of Streptococcus pneumoniae causing multidrug-resistant acute otitis media in children","volume":"15","author":"Xu","year":"2009","journal-title":"Emerg Infect Dis"},{"key":"2021030519532193500_CIT0017","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/INF.0b013e3181c1bc48","article-title":"New patterns in the otopathogens causing acute otitis media six to eight years after introduction of pneumococcal conjugate vaccine","volume":"29","author":"Casey","year":"2010","journal-title":"Pediatr Infect Dis J"},{"key":"2021030519532193500_CIT0018","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1080\/14760584.2018.1409116","article-title":"Review of vaccine effectiveness assumptions used in economic evaluations of infant pneumococcal conjugate vaccine","volume":"17","author":"Wasserman","year":"2018","journal-title":"Expert Rev Vaccines"},{"key":"2021030519532193500_CIT0019","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1186\/s12913-018-3139-1","article-title":"Trends in healthcare utilization and costs associated with acute otitis media in the United States during 2008\u20132014","volume":"18","author":"Tong","year":"2018","journal-title":"BMC Health Services Research"},{"key":"2021030519532193500_CIT0020","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1086\/598975","article-title":"Rationale for revised penicillin susceptibility breakpoints versus Streptococcus pneumoniae: coping with antimicrobial susceptibility in an era of resistance","volume":"48","author":"Weinstein","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2021030519532193500_CIT0021","first-page":"152","article-title":"Effect of new susceptibility breakpoints on reporting of resistance in Streptococcus pneumoniae\u2014United States, 2003","volume":"53","author":"Centers for Disease Control and Prevention","year":"2004","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2021030519532193500_CIT0022","volume-title":"Performance standards for antimicrobial susceptibility testing","author":"Clinical and Laboratory Standards Institute","year":"2017","edition":"27"},{"key":"2021030519532193500_CIT0023","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1093\/jac\/dkn538","article-title":"Susceptibilities of Haemophilus influenzae, Streptococcus pneumoniae, including serotype 19A, and Moraxella catarrhalis paediatric isolates from 2005 to 2007 to commonly used antibiotics","volume":"63","author":"Harrison","year":"2009","journal-title":"J Antimicrob Chemother"},{"key":"2021030519532193500_CIT0024","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2017-0181","article-title":"Epidemiology of acute otitis media in the postpneumococcal conjugate vaccine era","volume":"140","author":"Kaur","year":"2017","journal-title":"Pediatrics"},{"key":"2021030519532193500_CIT0025","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1097\/INF.0000000000001216","article-title":"Ten-year study of acute otitis media in Rochester, NY","volume":"35","author":"Pichichero","year":"2016","journal-title":"Pediatr Infect Dis J"},{"key":"2021030519532193500_CIT0026","volume-title":"Generalized linear models with random effects: unified analysis via H-likelihood","author":"Youngjo","year":"2006","edition":"2"},{"key":"2021030519532193500_CIT0027","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.meegid.2014.11.007","article-title":"Mechanisms of genome evolution of Streptococcus","volume":"33","author":"Andam","year":"2015","journal-title":"Infect Genet Evol"},{"key":"2021030519532193500_CIT0028","article-title":"An evolutionary model to predict the frequency of antibiotic resistance under seasonal antibiotic use, and an application to Streptococcus pneumoniae","volume":"284","author":"Blanquart","year":"2017","journal-title":"Proc Biol Sci"},{"key":"2021030519532193500_CIT0029","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/S1473-3099(04)00938-7","article-title":"Streptococcus pneumoniae colonisation: the key to pneumococcal disease","volume":"4","author":"Bogaert","year":"2004","journal-title":"Lancet Infect Dis"},{"key":"2021030519532193500_CIT0030","doi-asserted-by":"crossref","DOI":"10.1128\/mBio.00561-18","article-title":"A mechanism of unidirectional transformation, leading to antibiotic resistance, occurs within nasopharyngeal pneumococcal biofilm consortia","volume":"9","author":"Lattar","year":"2018","journal-title":"mBio"},{"key":"2021030519532193500_CIT0031","doi-asserted-by":"crossref","first-page":"514","DOI":"10.3201\/eid1003.030252","article-title":"Antibiotic selection pressure and resistance in Streptococcus pneumoniae and Streptococcus pyogenes","volume":"10","author":"Albrich","year":"2004","journal-title":"Emerg Infect Dis"},{"key":"2021030519532193500_CIT0032","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1046\/j.1365-2958.2003.03764.x","article-title":"From nose to lung: the regulation behind Streptococcus pneumoniae virulence factors","volume":"50","author":"Hava","year":"2003","journal-title":"Mol Microbiol"},{"key":"2021030519532193500_CIT0033","doi-asserted-by":"crossref","DOI":"10.3390\/genes8010039","article-title":"The complex relationship between virulence and antibiotic resistance","volume":"8","author":"Schroeder","year":"2017","journal-title":"Genes"},{"key":"2021030519532193500_CIT0034","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1089\/mdr.2008.0805","article-title":"Effects of the 7-valent pneumococcal conjugate vaccine on U.S. levofloxacin-resistant Streptococcus pneumoniae","volume":"14","author":"Davies","year":"2008","journal-title":"Microb Drug Resist"},{"key":"2021030519532193500_CIT0035","doi-asserted-by":"crossref","first-page":"e017715","DOI":"10.1136\/bmjopen-2017-017715","article-title":"Generalisability of vaccine effectiveness estimates: an analysis of cases included in a postlicensure evaluation of 13-valent pneumococcal conjugate vaccine in the USA","volume":"7","author":"Link-Gelles","year":"2017","journal-title":"BMJ Open"},{"key":"2021030519532193500_CIT0036","doi-asserted-by":"crossref","first-page":"e262","DOI":"10.1542\/peds.2013-1071","article-title":"Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years","volume":"132","author":"Wald","year":"2013","journal-title":"Pediatrics"},{"key":"2021030519532193500_CIT0037","first-page":"CD007880","article-title":"Antibiotics for preventing suppurative complications from undifferentiated acute respiratory infections in children under five years of age","volume":"2","author":"Alves Galvao","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2021030519532193500_CIT0038","first-page":"549","article-title":"Antibiotic treatment of acute otitis media [in French]","volume":"38","author":"Baron","year":"1991","journal-title":"Ann Pediatr"},{"key":"2021030519532193500_CIT0039","doi-asserted-by":"crossref","first-page":"243","DOI":"10.2165\/00148581-200911040-00003","article-title":"Variations in amoxicillin pharmacokinetic\/pharmacodynamic parameters may explain treatment failures in acute otitis media","volume":"11","author":"Pichichero","year":"2009","journal-title":"Paediatr Drugs"},{"key":"2021030519532193500_CIT0040","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.2147\/IDR.S165093","article-title":"Overview of pneumococcal serotypes and genotypes causing diseases in patients with chronic obstructive pulmonary disease in a Spanish hospital between 2013 and 2016","volume":"11","author":"Shoji","year":"2018","journal-title":"Infect Drug Resist"},{"key":"2021030519532193500_CIT0041","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11908-018-0607-z","article-title":"Prevention of invasive pneumococcal disease: problems emerged after some years of the 13-valent pneumococcal conjugate vaccine use","volume":"20","author":"Principi","year":"2018","journal-title":"Curr Infect Dis Rep"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaa157\/33370396\/ciaa157.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/72\/5\/797\/36415662\/ciaa157.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/72\/5\/797\/36415662\/ciaa157.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T20:04:04Z","timestamp":1614974644000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/72\/5\/797\/5739663"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,18]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,2,18]]},"published-print":{"date-parts":[[2021,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaa157","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,3,1]]},"published":{"date-parts":[[2020,2,18]]}}}