{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T20:23:40Z","timestamp":1776457420919,"version":"3.51.2"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"1","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["21IPA2111845"],"award-info":[{"award-number":["21IPA2111845"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1F31AI174773"],"award-info":[{"award-number":["1F31AI174773"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We aimed to estimate the burden of antibiotic-nonsusceptible nonbacteremic pneumonia and sinusitis due to Streptococcus pneumoniae (pneumococcus) in US adults (aged \u226518 years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We estimated antibiotic-nonsusceptible pneumococcal sinusitis and nonbacteremic pneumonia incidence as products of pneumococcal pneumonia and sinusitis incidence rates, serotype distribution, and serotype-specific antimicrobial nonsusceptibility prevalences from 2016 through 2019. Nonsusceptibility was considered by antibiotic class and guideline-recommended agents. We estimated pneumonia and sinusitis incidence rates from national surveys and administrative datasets and derived pneumococcal-attributable percents and serotype distributions from published data. Serotype-specific nonsusceptibility estimates were from Active Bacterial Core surveillance data. We evaluated nonsusceptibility for all serotypes and those targeted by 15-, 20-, and 21-valent pneumococcal conjugate vaccines (PCV15\/20\/21).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>An estimated 16.4% (95% confidence interval, 12.8\u201321.4) of nonbacteremic pneumococcal pneumonia and 19.0% (14.8\u201324.9%) of sinusitis cases were nonsusceptible to \u2265 3 antibiotic classes, translating to 243 521 (179 673\u2013333 675) and 1 844 726 (1 070 763\u20132 904 089) outpatient visits for pneumonia and sinusitis, respectively, and 10 155 (7542\u201313 803) pneumonia hospitalizations annually. An estimated 31.2% (26.6%\u201336.3%) of nonbacteremic pneumococcal pneumonia and 10.5% (9.4%\u201312.0%) of pneumococcal sinusitis cases were nonsusceptible to \u2265 1 outpatient first-line antibiotic agent. Cases attributable to serotypes targeted by PCV15, PCV20, and PCV21 that were nonsusceptible to \u22653 antibiotic classes accounted for 7.4% (4.7%\u201311.1%), 8.5% (5.8\u201312.1%), and 12.6% (9.2\u201317.5%) of nonbacteremic pneumococcal pneumonia, and 8.4% (5.3\u201312.5%), 9.4% (6.2\u201313.4), and 14.4% (10.4\u201320.0%) of pneumococcal sinusitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We estimated high proportions of antibiotic-nonsusceptibility in nonbacteremic pneumococcal pneumonia and sinusitis in US adults. Use of PCVs and antibiotic stewardship may mitigate the burden of antibiotic-nonsusceptible pneumococcal disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf774","type":"journal-article","created":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T12:41:58Z","timestamp":1767271318000},"source":"Crossref","is-referenced-by-count":1,"title":["Acute Respiratory Infections Due to Antibiotic-nonsusceptible\n                    <i>Streptococcus pneumoniae<\/i>\n                    in US Adults"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7785-4712","authenticated-orcid":false,"given":"Laura M","family":"King","sequence":"first","affiliation":[{"name":"Division of Epidemiology, School of Public Health, University of California , Berkeley, California ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0808-0231","authenticated-orcid":false,"given":"Kristin L","family":"Andrejko","sequence":"additional","affiliation":[{"name":"Pneumonia and Streptococcus Epidemiology Branch, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7544-0383","authenticated-orcid":false,"given":"Miwako","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Pneumonia and Streptococcus Epidemiology Branch, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8498-1149","authenticated-orcid":false,"given":"Wei","family":"Xing","sequence":"additional","affiliation":[{"name":"Pneumonia and Streptococcus Epidemiology Branch, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0591-1009","authenticated-orcid":false,"given":"Adam L","family":"Cohen","sequence":"additional","affiliation":[{"name":"Pneumonia and Streptococcus Epidemiology Branch, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph A","family":"Lewnard","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, School of Public Health, University of California , Berkeley, California ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"2026010712314685100_ofaf774-B1","author":"Centers for Disease Control and Prevention"},{"key":"2026010712314685100_ofaf774-B2","author":"World Health Organization"},{"key":"2026010712314685100_ofaf774-B3","first-page":"838","article-title":"Prevalence, clinical severity, and serotype distribution of pneumococcal pneumonia among adults hospitalized with community-acquired pneumonia in Tennessee and Georgia, 2018\u20132022","volume":"79","author":"Self","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2026010712314685100_ofaf774-B4","first-page":"821","article-title":"Outpatient visits and antibiotic use due to higher-valency pneumococcal vaccine serotypes","volume":"230","author":"King","year":"2024","journal-title":"J Infect Dis"},{"key":"2026010712314685100_ofaf774-B5","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1080\/14787210.2021.1858799","article-title":"Predictors of mortality in invasive pneumococcal disease: a meta-analysis","volume":"19","author":"Demirdal","year":"2021","journal-title":"Expert Rev Anti Infect Ther"},{"key":"2026010712314685100_ofaf774-B6","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1086\/500140","article-title":"The impact of penicillin resistance on short-term mortality in hospitalized adults with pneumococcal pneumonia: a systematic review and meta-analysis","volume":"42","author":"Tleyjeh","year":"2006","journal-title":"Clin Infect Dis"},{"key":"2026010712314685100_ofaf774-B7","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/2047-2994-3-16","article-title":"Attributable healthcare utilization and cost of pneumonia due to drug-resistant streptococcus pneumonia: a cost analysis","volume":"3","author":"Reynolds","year":"2014","journal-title":"Antimicrob Resist Infect Control"},{"key":"2026010712314685100_ofaf774-B8","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia. 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