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Data from 1997 to 2000 were pooled as pre-vaccination period. Trends over time were explored by linear regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2,077 isolates were analysed: 855 belonging to PCV7 serotypes, 466 to serotype 19A, 215 to serotype 3, 89 to serotype 6A and 452 to other serotypes (&lt; 40 isolates each). Over time, there has been a decreasing trend for PCV7 serotypes (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.944; p &lt; 0.001, with significant decreasing trends for serotypes 19F, 14, 23F and 9V), and increasing trends for serotype 19A (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.901; p &lt; 0.001), serotype 3 (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.463; p = 0.030) and other non-PCV7 serotypes (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.877; p &lt; 0.001), but not for serotype 6A (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.311; p = 0.094). Considering all isolates, amoxicillin non-susceptibility showed an increasing trend (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.528; p = 0.017). Regarding serotype 19A, increasing trends in non-susceptibility to penicillin (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.726; p = 0.001), amoxicillin (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.804; p &lt; 0.001), cefotaxime (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.546; p = 0.005) and erythromycin (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.546; p = 0.009) were found, with amoxicillin non-susceptibility firstly detected in 2003 (7.4%) and increasing up to 38.0% in 2009. In PCV7 serotypes (which prevalence decreased from 70.7% during 1997-2000 to 10.6% in 2009) amoxicillin non-susceptibility rates showed an increasing trend (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.702; p = 0.002). However, overall, amoxicillin non-susceptibility (\u224825% in 2008-9) could be mainly attributed to serotype 19A (&gt; 35% isolates) since PCV7 strains represented &lt; 11% of total clinical isolates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In contrast to reports on invasive pneumococcal strains, in MEF isolates the reduction in the prevalence of PCV7 serotypes was not associated with decreases in penicillin\/erythromycin non-susceptibility. The high prevalence of serotype 19A among paediatric MEF isolates and the amoxicillin non-susceptibility found in this serotype are worrisome since amoxicillin is the most common antibiotic used in the treatment of acute otitis media. These data suggest that non-PCV7 serotypes (mainly serotype 19A followed by serotypes 3 and 6A) are important etiological agents of acute otitis media and support the added value of the broader coverage of the new 13-valent conjugate vaccine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/1471-2334-11-239","type":"journal-article","created":{"date-parts":[[2011,9,13]],"date-time":"2011-09-13T03:02:43Z","timestamp":1315882963000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Increase in serotype 19A prevalence and amoxicillin non-susceptibility among paediatric Streptococcus pneumoniae isolates from middle ear fluid in a passive laboratory-based surveillance in Spain, 1997-2009"],"prefix":"10.1186","volume":"11","author":[{"given":"Asunci\u00f3n","family":"Fenoll","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Aguilar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Dolores","family":"Vicioso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Jose","family":"Gimenez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Robledo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan-Jose","family":"Granizo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2011,9,12]]},"reference":[{"key":"1576_CR1","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1128\/IAI.72.1.76-81.2004","volume":"72","author":"WP Hanage","year":"2004","unstructured":"Hanage WP, Auranen K, Syrj\u00e4nen R, Herva E, M\u00e4kel\u00e4 PH, Kilpi T, Spratt BG: Ability of pneumococcal serotypes and clones to cause acute otitis media: implications for the prevention of otitis media by conjugate vaccines. 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