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Increase of nonvaccine serotypes was observed among PNSSP. The most frequent PNSSP clones were the same as those identified in the pre-PCV7 era, although they were present in different proportions. Clonal expansion, emergence of new clones, and acquisition of penicillin resistance by established clones contributed to the maintenance of penicillin resistance.<\/jats:p>","DOI":"10.1128\/aac.00830-12","type":"journal-article","created":{"date-parts":[[2012,7,3]],"date-time":"2012-07-03T02:37:25Z","timestamp":1341283045000},"page":"4965-4968","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":24,"title":["Serotype and Clonal Evolution of Penicillin-Nonsusceptible Invasive Streptococcus pneumoniae in the 7-Valent Pneumococcal Conjugate Vaccine Era in Italy"],"prefix":"10.1128","volume":"56","author":[{"given":"Giovanni","family":"Gherardi","sequence":"first","affiliation":[{"name":"Centro Integrato di Ricerche, Laboratory of Microbiology, Universit\u00e0 Campus Biomedico, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"D'Ambrosio","sequence":"additional","affiliation":[{"name":"Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanit\u00e0, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Visaggio","sequence":"additional","affiliation":[{"name":"Centro Integrato di Ricerche, Laboratory of Microbiology, Universit\u00e0 Campus Biomedico, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giordano","family":"Dicuonzo","sequence":"additional","affiliation":[{"name":"Centro Integrato di Ricerche, Laboratory of Microbiology, Universit\u00e0 Campus Biomedico, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Del Grosso","sequence":"additional","affiliation":[{"name":"Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanit\u00e0, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annalisa","family":"Pantosti","sequence":"additional","affiliation":[{"name":"Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanit\u00e0, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00665-09"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jir052"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.0030168"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1402.070807"},{"key":"e_1_3_2_6_2","unstructured":"Clinical and Laboratory Standards Institute. 2010. 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