{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:02:59Z","timestamp":1784872979301,"version":"3.55.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Pneumococcal conjugate vaccines (PCVs) have transformed the epidemiology of pneumococcal disease while providing a real-world model for understanding how vaccination reshapes antimicrobial resistance (AMR) in\n                    <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                    . In this Mini Review, we examine PCV-associated AMR dynamics through linked epidemiological, ecological, and genomic processes. We first distinguish two complementary AMR-reducing pathways: direct suppression of vaccine-type serotypes that historically carried antibiotic-nonsusceptible lineages, and indirect reduction of antibiotic exposure by preventing pneumococcal and respiratory disease syndromes that commonly trigger empirical treatment. We then explain why these effects are incomplete. The capsular biosynthesis operon, antimicrobial resistance determinants, and virulence protein genes occupy distinct genomic layers; therefore, post-PCV AMR outcomes depend not only on serotype removal, but also on capsular switching, recombination, mobile resistance elements, lineage fitness, carriage reservoirs, and antibiotic selection. Recent whole-genome sequencing and Global Pneumococcal Sequence Cluster studies show that serotype replacement is best interpreted as lineage-level ecological restructuring, with region-specific consequences for resistant disease. We further discuss how global and regional epidemiology, including serotype-specific invasiveness and uneven vaccine uptake, modifies PCV-associated AMR impact. Finally, we consider higher-valency PCVs, protein-based vaccines, and trained-immunity-based host-directed strategies as complementary future directions. We argue that next-generation pneumococcal vaccines should be evaluated not only by immunogenicity and serotype coverage, but also by their effects on antibiotic use, carriage dynamics, resistant lineage expansion, capsular switching, and long-term population-genomic outcomes.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1903459","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:35:44Z","timestamp":1784871344000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pneumococcal conjugate vaccines and antimicrobial resistance: serotype replacement, clonal dynamics, and future vaccine perspectives"],"prefix":"10.3389","volume":"17","author":[{"given":"Ziyi","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Laboratory Medicine, Women and Children\u2019s Hospital of Tibet Autonomous Region","place":["Lhasa, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Blood Transfusion, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital","place":["Nanchong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanying","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Medical Laboratory, Dazhou Integrated Traditional Chinese Medicine & Western Medicine Hospital, Dazhou Second People\u2019s Hospital","place":["Dazhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liting","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingxin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linghan","family":"Kuang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Laboratory Medicine, Chengdu Hi-Tech Zone Hospital for Women and Children (Chengdu Hi-Tech Zone Hospital for Maternal and Child Healthcare)","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yali","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Laboratory Medicine, West China Second University Hospital (Tianfu), Sichuan University (Sichuan Provincial Children\u2019s Hospital)","place":["Meishan, China"]},{"name":"Department of Laboratory Medicine, Meishan Women and Children\u2019s Hospital, Alliance Hospital of West China Second University Hospital, Sichuan University","place":["Meishan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongmei","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry 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