{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T11:05:18Z","timestamp":1761563118985,"version":"build-2065373602"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"Supplement_4","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000313","name":"British Society for Antimicrobial Chemotherapy","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000313","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The BSAC Respiratory Surveillance Programme examined resistance trends among Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis from patients with community-acquired lower respiratory tract infection (CA-LRTI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Quotas of isolates were sought per collecting site from 1999\/00 to 2018\/19; an annual October start date captured winter infection peaks within single years. MIC testing was by BSAC agar dilution. \u03b2-Lactamase detection with nitrocefin and pneumococcal serotyping by classical methods or WGS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Resistances were uncommon, except that \u03b2-lactamases occurred in c. 20% of H. influenzae from 2012\/13 following earlier rises, and in &amp;gt;90% of M. catarrhalis throughout. Only 0.11% (12\/10881) of S. pneumoniae were fully resistant to penicillin; co-amoxiclav inhibited 97.8% of 13526 H. influenzae and &amp;gt;99.9% of 6309 M. catarrhalis isolates. Cefotaxime inhibited &amp;gt;99% of all isolates at breakpoint, as did relevant fluoroquinolones in the fewer years tested. Tetracycline inhibited &amp;gt;98% of H. influenzae and M. catarrhalis and 85% of S. pneumoniae. Significant shifts were: (i) fluctuating resistances to tetracyclines, macrolides and penicillin in pneumococci, reflecting serotype replacements; (ii) expansion, from 2012\/13, in the proportion of H. influenzae with \u03b2-lactamase-independent amoxicillin\/co-amoxiclav resistance; and (iii) increasing high-level amoxicillin resistance (MIC \u200a&amp;gt;\u200a64\u2005mg\/L) among \u03b2-lactamase-positive H. influenzae. MIC differentials were seen for cephalosporins between \u03b2-lactamase-positive and \u03b2-lactamase-negative M. catarrhalis, greatest (512-fold) for ceftaroline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CA-LRTI remains eminently treatable, yet shifts are occurring in the serotypes of S. pneumoniae most associated with resistance and in the nature of amoxicillin resistance in H. influenzae. \u03b2-Lactamase-related cephalosporin MIC differentials for M. catarrhalis are striking but their clinical significance remains uncertain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkaf252","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T07:20:21Z","timestamp":1751872821000},"page":"iv60-iv71","source":"Crossref","is-referenced-by-count":1,"title":["Antimicrobial resistance among agents of community-associated lower 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