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A phenotypic and genotypic analysis of the isolates was performed, including the identification of macrolide resistance genes\n                      <jats:italic>mef<\/jats:italic>\n                      (A), subclasses\n                      <jats:italic>mef<\/jats:italic>\n                      (A) and\n                      <jats:italic>mef<\/jats:italic>\n                      (E), as well as\n                      <jats:italic>erm<\/jats:italic>\n                      (B).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 1105 typeable\n                      <jats:italic>S<\/jats:italic>\n                      .\n                      <jats:italic>pneumoniae<\/jats:italic>\n                      isolates, 265 (24%) were macrolide-resistant; 22% in 2005, 33.3% in 2006, 23.7% in 2007, and 20.5% in 2009 (\n                      <jats:italic>P<\/jats:italic>\n                      =0.398). Among these macrolide-resistant pneumococci, 28.5% possessed\n                      <jats:italic>erm<\/jats:italic>\n                      (B), 24.3%\n                      <jats:italic>erm<\/jats:italic>\n                      (B)+\n                      <jats:italic>mef<\/jats:italic>\n                      (E), 41.8%\n                      <jats:italic>mef<\/jats:italic>\n                      (E), and 5.3%\n                      <jats:italic>mef<\/jats:italic>\n                      (A). A\n                      <jats:italic>mef<\/jats:italic>\n                      gene as the sole resistance determinant was carried by 31% of macrolide-resistant isolates belonging to PCV7 serotypes and 75.8% of the non-PCV7 serotypes. Across the 4 annual surveillances, pneumococci carrying\n                      <jats:italic>mef<\/jats:italic>\n                      (A) gradually disappeared, whereas serotype 19F isolates carrying both\n                      <jats:italic>erm<\/jats:italic>\n                      (B) and\n                      <jats:italic>mef<\/jats:italic>\n                      (E) persisted without significant yearly fluctuations. Among isolates belonging to non-PCV7 serotypes, macrolide-resistance was observed in those of serotypes 6A, 19A, 10A, 15A, 15B\/C, 35F, 35A, and 24F. In 2009, ie 5 years after the introduction of PCV7 in our country, 59% of macrolide-resistant pneumococci belonged to non-PCV7 serotypes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Across the study period, the annual frequency of macrolide-resistant isolates did not change significantly, but in 2009 a marked shift to non-PCV7 serotypes occurred. Overall, more than half of the macrolide-resistant isolates possessed\n                      <jats:italic>erm<\/jats:italic>\n                      (B) either alone or in combination with\n                      <jats:italic>mef<\/jats:italic>\n                      (E).\n                      <jats:italic>erm<\/jats:italic>\n                      (B) dominated among isolates belonging to PCV7 serotypes, but not among those of non-PCV7 serotypes.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/1471-2334-12-255","type":"journal-article","created":{"date-parts":[[2012,10,11]],"date-time":"2012-10-11T12:14:25Z","timestamp":1349957665000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Macrolide resistance determinants among Streptococcus pneumoniae isolates from carriers in Central Greece"],"prefix":"10.1186","volume":"12","author":[{"given":"Ioanna N","family":"Grivea","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexia","family":"Sourla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Ntokou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise C","family":"Chryssanthopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra G","family":"Tsantouli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A","family":"Syrogiannopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2012,10,11]]},"reference":[{"key":"2017_CR1","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1093\/clinids\/3.2.246","volume":"3","author":"JO Klein","year":"1981","unstructured":"Klein JO: The epidemiology of pneumococcal disease in infants and children. 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