Distribution of serotypes and antibiotic resistance profiles of Streptococcus pneumoniae in hospitalized adult patients: A retrospective multicenter surveillance in China (2018-2019)

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In China, pneumococcal infections pose a substantial disease burden, with rising antibiotic resistance. Although vaccines have effectively reduced disease worldwide, data on adult serotype distribution and resistance in China are scarce. This study investigates serotype patterns and antimicrobial susceptibility of S. pneumoniae among Chinese adults. Methods: We collected a total of 474 S. pneumoniae isolates from adult patients diagnosed with pneumococcal infections in 14 cities across five geographic regions of China between 2018 and 2019. Clinical specimens included sputum, blood, bronchoalveolar lavage fluid (BALF), cerebrospinal fluid (CSF), pharyngeal and nasal swabs, and middle ear fluid. Minimum inhibitory concentrations (MICs) of antimicrobial agents were determined using the agar dilution method. Pneumococcal serotyping was performed using the Pneumotest-Latex kit and type-specific antisera. Results: Serotype 19F was the most prevalent across all age groups, specimen types, and regions. 20-valent pneumococcal conjugate vaccine (PCV20) is expected to provide the highest serotype coverage (69.4%) among all vaccines evaluated. Multidrug resistance was detected in over 94% of isolates, with high resistance to macrolides, tetracycline, and clindamycin. β-lactam resistance varied by syndrome and region. Non-invasive isolates showed slightly higher resistance than invasive ones. Serotypes covered by higher-valency vaccines were more likely to be antibiotic-resistant, although fluoroquinolone and vancomycin resistance remained low. Conclusions: Our findings highlight a high burden of antimicrobial resistance and predominance of specific serotypes, particularly 19F, among adult S. pneumoniae isolates in China. The broad serotype coverage of PCV20 suggests its potential advantage in future adult immunization strategies. Continued surveillance of serotype distribution and resistance patterns is essential to inform vaccine policy and guide effective antibiotic use. Streptococcus pneumoniae Serotype Antimicrobial resistance Pneumococcal conjunctive vaccine adult China PCV20 Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Streptococcus pneumoniae ( S. pneumoniae ) is a leading bacterial cause of community acquired pneumonia (CAP), bacteremia, and meningitis worldwide (1). Although all ages groups are affected, pneumococcal disease significantly affects young children and the elderly, as well as individuals with certain chronic disease and immunocompromising conditions (2). Globally, pneumococcal-related respiratory infections are associated with a high mortality burden among adults aged over 70 years, with an estimated rate of 44.2 deaths per 100,000 population (3). In China, S. pneumoniae is an important pathogen for morbidity and mortality among children and older adults, and pneumococcal disease cases in China account for 12% of the total pneumococcal cases worldwide (4). Pneumococcal infections are estimated to cause approximately 89,593 deaths annually among adults older than 70 years in China, with a mortality rate of 82.98 per 100,000 population (5). Pneumococcal infections are treated with antibiotics, however, treatment may be complicated by the resistance to antibiotic therapies. S. pneumoniae isolates from adult patients show high resistance rates to common antibiotics in 2012-2017 (erythromycin, 90.8%, cefuroxime, 58.9%, and ceftriaxone 22.2%). In addition, a high multidrug resistance (MDR) rate was also observed (76.0%) (6). Immunization with vaccines against S. pneumoniae is the most effective public health measure for the prevention of pneumococcal infections. Available pneumococcal vaccines in China include a 23-valent pneumococcal polysaccharide vaccine (PPV23) and a 13-valent pneumococcal conjugate vaccine (PCV13). PPV23 is indicated for use in children aged 2 years or older and in adults (8). The 7-valent pneumococcal conjugate vaccine (PCV7), targeting serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F, was first licensed in China in 2008 for pediatric immunization. Building on the same conjugation technology, PCV13 expanded coverage to include six additional serotypes (1, 3, 5, 6A, 7F, and 19A) and received regulatory approval in China in 2016, however, exclusively to pediatric populations (9, 10). More than 100 distinct S. pneumoniae serotypes have been identified based on capsular polysaccharide structure, underscoring the complexity of vaccine development (7). Globally, Multiple countries have introduced PCVs into their national immunization programs for infants and children. Following the implementation of PCVs in these programs, substantial reductions in IPD, pneumonia, and otitis media have been observed in vaccinated children (11-13), as well as in adults through herd immunity (14). There is a need to directly protect the adults via PCV despite herd protection, therefore, PCV20 and PCV21 were both registered and recommended for adults since 2022, and now are scaling up worldwide (15). PPV23 vaccination among adults has been shown to effectively alleviate invasive pneumococcal diseases (IPD) burden in adults.(16, 17) This study was designed to investigate the distribution of pneumococcal serotypes and antimicrobial susceptibility of S. pneumoniae (2018-2019) to commonly used antimicrobial agents among Chinese adult patients. Bacterial isolates A total of 474 S. pneumoniae isolates were collected from adult patients with pneumococcal infections in 14 cities across 5 regions (North, South, East, West, and Central) of China between 2018 and 2019. The study protocols were approved by Ethics Committee of the Pecking University People’s Hospital and all participants provided written informed consent prior to study commencement. One isolate was collected from each patient. Duplicate isolates and patients colonized by bacteria but without any clinical evidence of infection were excluded. Isolates were obtained from sputum, blood, broncho-alveolar lavage fluid (BALF), cerebrospinal fluid (CSF), pharyngeal swabs, nasal swabs, and middle ear fluid, etc. S. pneumoniae isolates from sputum were included if they met the following criteria: less than 10 squamous epithelial cells and more than 25 leukocytes per low power field. Isolates were transported to Peking University People’s Hospital for antibiotic susceptibility testing and serotyping annually. Isolates were identified based on typical colony morphology, Gram staining, optochin sensitivity tests (Oxoid, Hampshire, UK), and Omni serum assays (Statens Serum Institut, Copenhagen, Denmark). In vitro antimicrobial susceptibility testing The agar dilution method was used to determine the minimum inhibitory concentrations (MICs) of the 474 S. pneumoniae isolates against 15 antibiotics (penicillin, amoxicillin/clavulanic acid, ceftriaxone, cefuroxime, cefaclor, vancomycin, erythromycin, azithromycin, clarithromycin, tetracycline, levofloxacin, moxifloxacin, trimethoprim/ sulfamethoxazole, chloramphenicol and clindamycin) in accordance with the guidelines established by the Clinical and Laboratory Standards Institute (CLSI). The CLSI 2023 criteria for MICs were applied to classify isolates as susceptible, intermediate, or resistant (18). The oral penicillin breakpoint was used to classify isolates as penicillin susceptible (MIC ≤0.06 μg/ml), penicillin-intermediate (MIC between 0.12 and 1 μg/ml), or penicillin-resistant (MIC ≥2 μg/ml). For ceftriaxone, the non-meningitis breakpoint was used to classify isolates as susceptible (MIC ≤1 μg/ml) or resistant (MIC ≥4 μg/ml) (17). S. pneumoniae ATCC 49619 was used as the quality control strain and was included in each set of tests to ensure accurate results. Multidrug-resistant (MDR) S. pneumoniae isolates were defined as isolates that were resistant to ≥3 classes of antimicrobial agents. Pneumococcal serotyping Pneumococcal serotypes/groups were determined for the 474 isolates with Pneumotest-Latex kit (Statens Serum Institut, Copenhagen, Denmark) and type-specific antisera (Statens Serum Institut, Copenhagen, Denmark). The Pneumotest-Latex kit consisted of the 14 latex reagents pools A-I and P-Q. By testing all 14 pools and using the chessboard identification system, it was possible to identify the 23 vaccine serotypes to type/group level. Traditional quellung reaction with type-specific antisera was used for full serotyping of serogroup 19, 6 and 23. The coverages of PCV13, PCV15, PCV20, PCV21 and PPV23 vaccines were estimated by calculating the percentage of isolates that expressed the serotypes included in the vaccines. Statistical Analysis Descriptive, non-comparative analysis was used in this study. Frequency distributions that provided the number and percentage of pneumococcal isolates per serotype were calculated for all serotypes identified in this study. Serotypes were grouped by PCV13, PCV15, PCV20, PCV21 and PPV23 coverage. Breakdowns of serotypes by age groups (18-49, 50-59, 60-69, ≥70) for above serotype distribution were also presented. The number and percentage of susceptible, intermediate, and resistant serotypes of S. pneumoniae isolates were calculated. Overall frequency distribution of susceptible, intermediate, and resistant serotypes was given for each antibiotic. The data were analyzed using the R software (version 4.4.2). Results Characteristics of pneumococcal isolates During the study period, a total of 474 S. pneumoniae isolates were collected, with 66.9% derived from male patients and 33.1% from females. Patients aged 70 years and older accounted for the largest proportion (35.7%) among all age groups. Most isolates were obtained from non-invasive specimens (89.2%), while 10.8% were from invasive sources such as blood and cerebrospinal fluid. Geographically, most isolates were collected from northern China (46.2%), followed by the western (23.9%), eastern (15.6%), southern (11.0%), and central (3.4%) regions (Table 1, Figure 1). Serotype distribution The serotype distribution of the isolates is presented in Table 2. Overall, serotype 19F was the most prevalent (24.9%), followed by 19A (10.3%), 23F (9.5%), 6A (5.9%), and 15A (5.3%) (Figure 2). Across all age groups, 19F remained the predominant serotype, ranging from 16.9% (50-59 years) to 30.2% (≥70 years). Similarly, 19F was the most prevalent serotype across all geographic regions, ranging from 22.4% (northern) to 31.2% (central). In the eastern and western regions, 19A was the second most common serotype, accounting for 16.2% and 13.3% of isolates, respectively, whereas in the southern, northern, and central regions, 23F ranked second (13.5%, 9.6%, and 12.5%, respectively). Serotype 19F maintained dominance in both invasive and non-invasive specimens, with respective prevalence rates of 27.5% and 24.6%. Notably, among invasive isolates, serotype 6A (11.8%) emerged as the secondary variant, closely trailing 19F. A parallel pattern was observed in older adults (60-69 years), where 19F retained prominence at 16.9%, while 6A constituted the second most prevalent serotype (11.3%). Vaccine coverage across different groups is presented in Table 3. Among all isolates, PCV20 demonstrated the highest overall coverage (69.4%), followed by PPV23 (65.4%), PCV15 (MSD) (63.7%), and PCV13 (62.9%). PCV21 had the lowest coverage (36.1%), while 18.6% of isolates were not covered by any of the evaluated vaccines. Across all age groups, PCV20 consistently showed the highest coverage, ranging from 67.6% (60-69 years) to 72.5% (50-59 years). Regionally, PCV20 had the highest coverage in all areas except the central region, where PPV23 coverage (75.0%) was the highest. Similarly, PCV20 demonstrated the greatest coverage in both invasive (80.4%) and non-invasive (68.1%) specimens. Antibiotic Resistance Profiles of S. pneumoniae across Regions Antibiotic resistance among S. pneumoniae isolates from hospitalized adult patients in China was notably high, with multidrug resistance (MDR) detected in 94.06% of cases (Figure 3). Resistance to macrolides was particularly widespread, with over 90% of isolates exhibiting resistance to erythromycin, azithromycin, and clarithromycin. Similarly, high resistance rates were observed for tetracycline (89.64%) and clindamycin (87.92%). Penicillin resistance was 57.14% in meningitis cases and 45.81% in oral treatment cases. Ceftriaxone resistance was lower, with 28.57% for meningitis and 15.67% for non-meningitis cases. Trimethoprim-sulfamethoxazole resistance was moderate (58.05%), while resistance to amoxicillin (16.70%) and chloramphenicol (8.44%) was relatively low. Fluoroquinolone resistance was rare, and no vancomycin resistance was detected. Regional variations were evident in antibiotic resistance patterns. Macrolide and tetracycline resistance were consistently high across all regions, while β-lactam resistance varied. Notably, the East and West regions exhibited higher resistance rates for several antibiotics, whereas resistance to ceftriaxone (meningitis) was lowest in the East and highest in the West. Chloramphenicol resistance was highest in the Central region. The detailed distribution of antibiotic resistance rates across different regions is shown in Table 4. The comparison of antibiotic resistance profiles between invasive and non-invasive isolates is summarized in Table 5. Antibiotic Resistance Profiles of S. pneumoniae by Vaccine Types Antibiotic resistance patterns differed between invasive and non-invasive S. pneumoniae isolates (Figure 4). Overall, multidrug resistance (MDR) was highly prevalent in both groups, with slightly higher resistance rates observed in non-invasive isolates (94.29%) compared to invasive isolates (92.16%). Resistance to macrolides, including erythromycin, azithromycin, and clarithromycin, was consistently high, exceeding 90% in both invasive and non-invasive isolates. Tetracycline resistance was also substantial, reaching 96.08% in invasive isolates and 91.92% in non-invasive isolates. Clindamycin resistance followed a similar trend, with rates of 82.35% and 88.60% in invasive and non-invasive isolates, respectively. For β-lactam antibiotics, cefaclor resistance was higher in non-invasive isolates (65.88%) than in invasive isolates (49.02%). Trimethoprim-sulfamethoxazole resistance was similar between the two groups (49.02% vs. 59.14%). Resistance to penicillin varied by clinical syndrome, with meningitis-associated strains showing higher resistance (57.14% in invasive isolates and 55.45% in non-invasive isolates) compared to non-meningitis-associated strains (2.27% and 3.08%, respectively). Third-generation cephalosporin resistance was relatively lower, with cefuroxime resistance at 39.22% (invasive) and 49.76% (non-invasive), and ceftriaxone resistance for meningitis cases at 28.57% (invasive) and 47.87% (non-invasive). Fluoroquinolone resistance remained low, with levofloxacin resistance below 5% and moxifloxacin resistance nearly absent. Vancomycin resistance was not detected in any isolate. When stratified by vaccine serotype coverage, resistance rates varied across pneumococcal vaccines (PCV13, PCV15, PCV20, PCV21, and PPV23) (Figure 5). Serotypes covered by the higher-valency vaccines (PCV20 and PCV21) tended to exhibit higher resistance to macrolides, tetracyclines, and clindamycin, suggesting that resistant strains are more likely to be found within these serotypes. Penicillin resistance, particularly in meningitis-associated strains, remained moderate among serotypes covered by different vaccine formulations, while resistance to fluoroquinolones and vancomycin was consistently low across all vaccine serotype groups. Antibiotic resistance patterns among isolates stratified by vaccine coverage (PCV13, PCV15, PCV20, PCV21, PPV23) are presented in Table 6. Discussion In this multicenter study conducted in China, we evaluated the serotype distribution and antimicrobial susceptibility of S. pneumoniae isolates cultured from adult patients. A total of 474 pneumococcal isolates were obtained, with serotype 19F being the most prevalent (24.9%), followed by 19A (10.3%), 23F (9.5%) and 6A (5.9%), consistent with findings from previous studies conducted in China (19). The predominance of serotype 19F across age groups, geographic regions, and specimen sources observed in this study highlights its continued circulation in the adult population in China. However, our results differ from those reported in other regions, as recent studies have highlighted notable geographic variation in pneumococcal serotype distribution. For instance, the predominant serotypes identified in the United States include 3, 22F, 19A, 35B, 9N, and 19F, in Korea, serotypes 3, 10A, 19A, and 23A are most frequently observed, whereas in Japan, 35B, 11A, and 3 are the most common (20-23). One multi-center study from 2009 to 2015 when the PCV13 (including serotype 3) was not available in China reported that serotype 3 was the most predominant serotype (21.7%), followed by 19F, 19 A and 23F. However, we have not yet identify any studies with serotype 3 as a top serotype since the launch of PCV13 in China (23). With regard to vaccine coverage, PCV20 provided the highest overall coverage (69.4%) among all evaluated vaccines and consistently outperformed other formulations across all age groups and regions, except in the central region where PPV23 showed slightly higher coverage (75.0%). Notably, PCV20 also demonstrated the greatest coverage in both invasive and non-invasive isolates, suggesting its potential utility in broader adult immunization strategies. Similar to our findings, a study from Turkey reported that among adults aged 18-64 years, serotype coverage rates were 62.8% for PCV13, 65.1% for PCV15, 71.0% for PCV20, and 74.3% for PPV23. In adults aged ≥65 years, the corresponding coverage rates were 66.0%, 69.5%, 80.1%, and 78.7%, respectively (24). Our study highlights the extensive antibiotic resistance among S. pneumoniae isolates from hospitalized adult patients in China, with particularly high rates of MDR and significant regional and strain-specific variations. These findings emphasize the urgent need for improved antimicrobial stewardship and vaccination strategies to mitigate the burden of antibiotic-resistant pneumococcal infections. The observed MDR prevalence of 94.06% aligns with previous reports of high resistance rates in Asia (25). Macrolide resistance exceeding 90% for erythromycin, azithromycin, and clarithromycin suggests widespread dissemination of resistance determinants, likely driven by the overuse of these antibiotics in outpatient settings (26). Tetracycline (89.64%) and clindamycin (87.92%) resistance further reflect the impact of selective pressure from commonly prescribed antibiotics (27). Conversely, low fluoroquinolone resistance and absence of vancomycin resistance provide critical insights into potential treatment options for severe pneumococcal infections (28). The substantial variation in resistance rates across regions suggests distinct antibiotic prescribing practices and potential differences in circulating pneumococcal lineages. The East and West regions demonstrated higher resistance to β-lactam antibiotics, which may reflect differences in healthcare infrastructure, antibiotic use regulations, and local epidemiology. Notably, ceftriaxone resistance was lowest in the East and highest in the West, highlighting potential geographic disparities in treatment efficacy. MDR was slightly higher in non-invasive isolates (94.29%) compared to invasive isolates (92.16%), consistent with prior findings (29). Unlike invasive isolates, which primarily cause bloodstream and cerebrospinal infections, non-invasive strains colonize the nasopharynx and are frequently exposed to subtherapeutic antibiotic levels, promoting horizontal gene transfer of resistance determinants (30). Additionally, non-invasive pneumococcal strains often carry mobile genetic elements, such as transposons and plasmids, facilitating the acquisition of resistance genes (Cohen et al., 2019). Resistance patterns differed by syndrome, with higher penicillin resistance in meningitis-associated strains, particularly in invasive isolates (57.14%). This could be due to the limited penetration of β-lactam antibiotics into the cerebrospinal fluid (CSF), leading to subtherapeutic drug concentrations that select for resistant strains. Additionally, meningitis-associated strains often belong to hypervirulent, multidrug-resistant clones that harbor penicillin-binding protein (PBP) mutations, further reducing β-lactam efficacy. The relatively lower resistance to third-generation cephalosporins (ceftriaxone and cefuroxime) suggests their continued role in treatment, albeit with caution due to rising resistance trends. Serotype-specific resistance patterns indicate that strains covered by higher-valency pneumococcal vaccines (PCV20) exhibited greater macrolide, tetracycline, and clindamycin resistance, suggesting that antibiotic-resistant pneumococcal serotypes are more prevalent within vaccine-covered groups. This finding underscores the need for continued surveillance to assess the impact of serotype replacement and vaccine effectiveness in reducing antibiotic-resistant pneumococcal infections. Declarations Ethics approval and consent to participate Approved by the Ethics Committee of Peking University People's Hospital, approval No. 2018PHB129. Clinical trial Not applicable. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors’ contributions H.W. and C.Z. contributed to study design and data acquisition. Z.W. F.Z. and S.Y. performed microbiological testing. H.C. analyzed the data and prepared figures. H.W. and C.Z. drafted the manuscript. All authors (C.Z., F.Z., Z.W., S.Y., H.C., and H.W.) reviewed and approved the final manuscript. Acknowledgements We thank the participating hospitals and laboratory staff for their contributions to specimen collection and analysis. References Weiser JN, Ferreira DM, Paton JC. Streptococcus pneumoniae: transmission, colonization and invasion. Nat Rev Microbiol. 2018,16(6):355-67. Wahl B, O'Brien KL, Greenbaum A, Majumder A, Liu L, Chu Y, et al. Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15. The Lancet Global health. 2018,6(7):e744-e57. Yu X, Wang H, Ma S, Chen W, Sun L, Zou Z. 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Community prescribing and resistant Streptococcus pneumoniae. Emerg Infect Dis. 2005,11(6):829-37. Rodriguez CA, Atkinson R, Bitar W, Whitney CG, Edwards KM, Mitchell L, et al. Tolerance to vancomycin in pneumococci: detection with a molecular marker and assessment of clinical impact. J Infect Dis. 2004,190(8):1481-7. Higgs C, Kumar LS, Stevens K, Strachan J, Korman T, Horan K, et al. Comparison of contemporary invasive and non-invasive Streptococcus pneumoniae isolates reveals new insights into circulating anti-microbial resistance determinants. Antimicrob Agents Chemother. 2023,67(11):e0078523. Nielsen KL, Hammerum AM, Lambertsen LM, Lester CH, Arpi M, Knudsen JD, et al. Characterization and transfer studies of macrolide resistance genes in Streptococcus pneumoniae from Denmark. Scand J Infect Dis. 2010,42(8):586-93. Tables Table 1. Characteristics of patients with collected S. pneumoniae isolates Characteristics No. Percentage (%) Total 474 100.0 Gender Male 317 66.9 Female 157 33.1 Age group (years) 18-49 72 15.2 50-59 91 19.2 60-69 142 30.0 ≥70 169 35.7 Specimen source Non-invasive 423 89.2 Sputum 334 70.5 Bronchoalveolar lavage 52 11 Nose 14 3 Secretions 5 1.1 Brush biopsy 4 0.8 Sinus 4 0.8 Pus 3 0.6 Urine 3 0.6 Drainage 2 0.4 Ear 1 0.2 Throat swab 1 0.2 Invasive 51 10.8 Blood 41 8.6 Cerebrospinal fluid 7 1.5 Eye (Sterile) 2 0.4 Pleural fluid 1 0.2 Region (city, province) East 74 15.6 Dong'a County People's Hospital (Dong’a, Shandong) 22 4.6 Shandong Provincial Hospital (Jinan, Shandong) 22 4.6 Taian Central Hospital (Taian, Shandong) 30 6.3 South 52 11.0 Guangzhou Institute of Respiratory Health (Guangzhou, Guangdong) 20 4.2 Liuzhou People's Hospital (Liuzhou, Guangxi) 30 6.3 Liuzhou Maternal and Child Health Hospital (Liuzhou, Guangxi) 1 0.2 The First Affiliated Hospital of Sun Yat-sen University (Guangzhou, Guangdong) 1 0.2 West 113 23.9 Ningxia Medical University General Hospital (Yinchuan, Ningxia) 28 5.9 The Third Hospital of Mianyang (Mianyang, Sichuan) 42 8.9 West China Hospital of Sichuan University (Chengdu, Sichuan) 22 4.6 Xijing Hospital (Xian, Shannxi) 21 4.4 North 219 46.2 Beijing Tsinghua Chang Gung Memorial Hospital (Beijing) 6 1.3 Beijing Chaoyang Hospital (Beijing) 79 16.7 China-Japan Friendship Hospital (Beijing) 40 8.4 China Medical University Shengjing Hospital (Shenyang, Liaoning) 19 4.0 Jilin University Sino-Japanese Friendship Hospital (Changchun, Jilin) 3 0.6 Peking University People's Hospital (Beijing) 72 15.2 Central 16 3.4 Wuhan Fourth Hospital (Wuhan, Hubei) 13 2.7 Xiangya Hospital Central South University (Changsha, Hunan) 1 0.2 Hunan Provincial People's Hospital (Changsha, Hunan) 2 0.4 Table 2. Serotype distribution of S.pneumoniae [n (%)] Serotype Total (n=474) Age group Region Specimen source 18-49 (n=72) 50-59 (n=91) 60-69 (n=142) ≥70 (n=169) East (n=74) South (n=52) West (n=113) North (n=219) Central (n=16) Invasive (n=51) Non-invasive (n=423) Vaccine 1 2 (0.4) 0 (0.0) 0 (0.0) 1 (0.7) 1 (0.6) 0 (0.0) 1 (1.9) 0 (0.0) 1 (0.5) 0 (0.0) 1 (2.0) 1 (0.2) 3 7 (1.5) 1 (1.4) 4 (4.4) 0 (0.0) 2 (1.2) 1 (1.4) 0 (0.0) 1 (0.9) 4 (1.8) 1 (6.2) 1 (2.0) 6 (1.4) 4 1 (0.2) 1 (1.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.9) 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.0) 0 (0.0) 5 1 (0.2) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.6) 1 (1.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.2) 6A 28 (5.9) 2 (2.8) 7 (7.7) 16 (11.3) 3 (1.8) 5 (6.8) 2 (3.8) 8 (7.1) 13 (5.9) 0 (0.0) 6 (11.8) 22 (5.2) 6B 10 (2.1) 0 (0.0) 1 (1.1) 4 (2.8) 5 (3.0) 4 (5.4) 2 (3.8) 2 (1.8) 2 (0.9) 0 (0.0) 1 (2.0) 9 (2.1) 7F 6 (1.3) 1 (1.4) 0 (0.0) 3 (2.1) 2 (1.2) 1 (1.4) 0 (0.0) 3 (2.7) 2 (0.9) 0 (0.0) 1 (2.0) 5 (1.2) 8 2 (0.4) 0 (0.0) 0 (0.0) 1 (0.7) 1 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) 2 (0.9) 0 (0.0) 0 (0.0) 2 (0.5) 9N 1 (0.2) 0 (0.0) 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) 0 (0.0) 0 (0.0) 1 (0.2) 9V 7 (1.5) 0 (0.0) 3 (3.3) 1 (0.7) 3 (1.8) 2 (2.7) 0 (0.0) 0 (0.0) 4 (1.8) 1 (6.2) 1 (2.0) 6 (1.4) 10A 4 (0.8) 1 (1.4) 0 (0.0) 1 (0.7) 2 (1.2) 0 (0.0) 0 (0.0) 1 (0.9) 3 (1.4) 0 (0.0) 0 (0.0) 4 (0.9) 11A 13 (2.7) 4 (5.6) 4 (4.4) 4 (2.8) 1 (0.6) 4 (5.4) 2 (3.8) 2 (1.8) 4 (1.8) 1 (6.2) 1 (2.0) 12 (2.8) 12F 1 (0.2) 1 (1.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.2) 14 20 (4.2) 4 (5.6) 2 (2.2) 7 (4.9) 7 (4.1) 3 (4.1) 2 (3.8) 4 (3.5) 11 (5.0) 0 (0.0) 3 (5.9) 17 (4.0) 15A 25 (5.3) 0 (0.0) 7 (7.7) 10 (7.0) 8 (4.7) 3 (4.1) 3 (5.8) 11 (9.7) 7 (3.2) 1 (6.2) 0 (0.0) 25 (5.9) 15B 7 (1.5) 2 (2.8) 1 (1.1) 2 (1.4) 2 (1.2) 1 (1.4) 0 (0.0) 1 (0.9) 5 (2.3) 0 (0.0) 1 (2.0) 6 (1.4) 15C 2 (0.4) 0 (0.0) 0 (0.0) 1 (0.7) 1 (0.6) 0 (0.0) 0 (0.0) 1 (0.9) 1 (0.5) 0 (0.0) 0 (0.0) 2 (0.5) 16F 3 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) 3 (1.8) 1 (1.4) 0 (0.0) 1 (0.9) 1 (0.5) 0 (0.0) 0 (0.0) 3 (0.7) 17F 2 (0.4) 0 (0.0) 0 (0.0) 1 (0.7) 1 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) 2 (0.9) 0 (0.0) 1 (2.0) 1 (0.2) 18C 4 (0.8) 0 (0.0) 0 (0.0) 1 (0.7) 3 (1.8) 2 (2.7) 0 (0.0) 0 (0.0) 2 (0.9) 0 (0.0) 0 (0.0) 4 (0.9) 19A 49 (10.3) 7 (9.7) 9 (9.9) 14 (9.9) 19 (11.2) 12 (16.2) 1 (1.9) 15 (13.3) 20 (9.1) 1 (6.2) 6 (11.8) 43 (10.2) 19F 118 (24.9) 16 (22.2) 27 (29.7) 24 (16.9) 51 (30.2) 20 (27.0) 15 (28.8) 29 (25.7) 49 (22.4) 5 (31.2) 14 (27.5) 104 (24.6) 20 6 (1.3) 0 (0.0) 2 (2.2) 0 (0.0) 4 (2.4) 0 (0.0) 0 (0.0) 1 (0.9) 4 (1.8) 1 (6.2) 0 (0.0) 6 (1.4) 22F 1 (0.2) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.6) 0 (0.0) 0 (0.0) 1 (0.9) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.2) 23A 9 (1.9) 3 (4.2) 0 (0.0) 1 (0.7) 5 (3.0) 1 (1.4) 3 (5.8) 1 (0.9) 4 (1.8) 0 (0.0) 1 (2.0) 8 (1.9) 23B 6 (1.3) 1 (1.4) 1 (1.1) 3 (2.1) 1 (0.6) 0 (0.0) 1 (1.9) 1 (0.9) 4 (1.8) 0 (0.0) 1 (2.0) 5 (1.2) 23F 45 (9.5) 11 (15.3) 8 (8.8) 14 (9.9) 12 (7.1) 5 (6.8) 7 (13.5) 10 (8.8) 21 (9.6) 2 (12.5) 2 (3.9) 43 (10.2) 31 1 (0.2) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) 0 (0.0) 0 (0.0) 1 (0.2) 33F 3 (0.6) 0 (0.0) 0 (0.0) 3 (2.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 3 (1.4) 0 (0.0) 2 (3.9) 1 (0.2) 35B 2 (0.4) 0 (0.0) 0 (0.0) 1 (0.7) 1 (0.6) 0 (0.0) 0 (0.0) 1 (0.9) 1 (0.5) 0 (0.0) 0 (0.0) 2 (0.5) Non-vaccine 7A 1 (0.2) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.6) 1 (1.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.2) 9A 2 (0.4) 0 (0.0) 1 (1.1) 1 (0.7) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.9) 1 (0.5) 0 (0.0) 0 (0.0) 2 (0.5) 11F 2 (0.4) 1 (1.4) 0 (0.0) 1 (0.7) 0 (0.0) 1 (1.4) 0 (0.0) 0 (0.0) 1 (0.5) 0 (0.0) 0 (0.0) 2 (0.5) 13 8 (1.7) 1 (1.4) 0 (0.0) 2 (1.4) 5 (3.0) 1 (1.4) 0 (0.0) 1 (0.9) 6 (2.7) 0 (0.0) 0 (0.0) 8 (1.9) 15F 7 (1.5) 2 (2.8) 0 (0.0) 3 (2.1) 2 (1.2) 0 (0.0) 0 (0.0) 0 (0.0) 7 (3.2) 0 (0.0) 1 (2.0) 6 (1.4) 16A 3 (0.6) 0 (0.0) 0 (0.0) 1 (0.7) 2 (1.2) 0 (0.0) 0 (0.0) 2 (1.8) 1 (0.5) 0 (0.0) 0 (0.0) 3 (0.7) 17A 1 (0.2) 0 (0.0) 1 (1.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) 0 (0.0) 0 (0.0) 1 (0.2) 21 1 (0.2) 0 (0.0) 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (6.2) 0 (0.0) 1 (0.2) 24A 2 (0.4) 0 (0.0) 1 (1.1) 1 (0.7) 0 (0.0) 0 (0.0) 0 (0.0) 2 (1.8) 0 (0.0) 0 (0.0) 0 (0.0) 2 (0.5) 25A 2 (0.4) 2 (2.8) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.9) 1 (0.5) 0 (0.0) 0 (0.0) 2 (0.5) 28A 7 (1.5) 0 (0.0) 1 (1.1) 3 (2.1) 3 (1.8) 0 (0.0) 0 (0.0) 1 (0.9) 5 (2.3) 1 (6.2) 0 (0.0) 7 (1.7) 28F 11 (2.3) 4 (5.6) 2 (2.2) 2 (1.4) 3 (1.8) 1 (1.4) 1 (1.9) 2 (1.8) 7 (3.2) 0 (0.0) 3 (5.9) 8 (1.9) 29 4 (0.8) 1 (1.4) 1 (1.1) 1 (0.7) 1 (0.6) 0 (0.0) 1 (1.9) 1 (0.9) 2 (0.9) 0 (0.0) 0 (0.0) 4 (0.9) 34 4 (0.8) 0 (0.0) 1 (1.1) 1 (0.7) 2 (1.2) 1 (1.4) 2 (3.8) 0 (0.0) 1 (0.5) 0 (0.0) 0 (0.0) 4 (0.9) 35 2 (0.4) 1 (1.4) 0 (0.0) 0 (0.0) 1 (0.6) 1 (1.4) 1 (1.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (0.5) 35A 2 (0.4) 0 (0.0) 0 (0.0) 1 (0.7) 1 (0.6) 0 (0.0) 0 (0.0) 2 (1.8) 0 (0.0) 0 (0.0) 0 (0.0) 2 (0.5) 35C 3 (0.6) 0 (0.0) 2 (2.2) 1 (0.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (0.9) 1 (6.2) 0 (0.0) 3 (0.7) 35F 2 (0.4) 0 (0.0) 1 (1.1) 1 (0.7) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.9) 1 (0.5) 0 (0.0) 0 (0.0) 2 (0.5) 36 3 (0.6) 1 (1.4) 1 (1.1) 0 (0.0) 1 (0.6) 0 (0.0) 3 (5.8) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 3 (0.7) 37 5 (1.1) 1 (1.4) 2 (2.2) 1 (0.7) 1 (0.6) 0 (0.0) 0 (0.0) 1 (0.9) 4 (1.8) 0 (0.0) 0 (0.0) 5 (1.2) 39 1 (0.2) 0 (0.0) 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) 0 (0.0) 1 (2.0) 0 (0.0) 42 6 (1.3) 1 (1.4) 1 (1.1) 3 (2.1) 1 (0.6) 0 (0.0) 1 (1.9) 2 (1.8) 3 (1.4) 0 (0.0) 0 (0.0) 6 (1.4) 47 2 (0.4) 1 (1.4) 0 (0.0) 0 (0.0) 1 (0.6) 0 (0.0) 1 (1.9) 0 (0.0) 1 (0.5) 0 (0.0) 1 (2.0) 1 (0.2) 47A 2 (0.4) 0 (0.0) 0 (0.0) 2 (1.4) 0 (0.0) 1 (1.4) 0 (0.0) 1 (0.9) 0 (0.0) 0 (0.0) 1 (2.0) 1 (0.2) 47F 4 (0.8) 1 (1.4) 0 (0.0) 1 (0.7) 2 (1.2) 1 (1.4) 1 (1.9) 0 (0.0) 2 (0.9) 0 (0.0) 0 (0.0) 4 (0.9) 48 1 (0.2) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.6) 0 (0.0) 0 (0.0) 1 (0.9) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.2) Table 3. Vaccine coverage across different groups [n (%)] Vaccine Total (n=474) Age group Region Specimen source 18-49 (n=72) 50-59 (n=91) 60-69 (n=142) ≥70 (n=169) East (n=74) South (n=52) West (n=113) North (n=219) Central (n=16) Invasive (n=51) Non-invasive (n=423) PCV13 298 (62.9) 43 (59.7) 61 (67.0) 85 (59.9) 109 (64.5) 56 (75.7) 31 (59.6) 72 (63.7) 129 (58.9) 10 (62.5) 37 (72.5) 261 (61.7) PCV15 (MSD) 302 (63.7) 43 (59.7) 61 (67.0) 88 (62.0) 110 (65.1) 56 (75.7) 31 (59.6) 73 (64.6) 132 (60.3) 10 (62.5) 39 (76.5) 263 (62.2) PCV15 (Zhifei) 299 (63.1) 44 (61.1) 61 (67.0) 85 (59.9) 109 (64.5) 56 (75.7) 32 (61.5) 72 (63.7) 129 (58.9) 10 (62.5) 37 (72.5) 262 (61.9) PCV20 329 (69.4) 51 (70.8) 66 (72.5) 96 (67.6) 116 (68.6) 61 (82.4) 34 (65.4) 77 (68.1) 146 (66.7) 11 (68.8) 41 (80.4) 288 (68.1) PCV21 171 (36.1) 21 (29.2) 34 (37.4) 60 (42.3) 56 (33.1) 28 (37.8) 13 (25.0) 48 (42.5) 77 (35.2) 5 (31.2) 20 (39.2) 151 (35.7) PPV23 310 (65.4) 49 (68.1) 61 (67.0) 82 (57.7) 118 (69.8) 56 (75.7) 32 (61.5) 70 (61.9) 140 (63.9) 12 (75.0) 36 (70.6) 274 (64.8) Non-vaccine 88 (18.6) 17 (23.6) 15 (16.5) 28 (19.7) 28 (16.6) 8 (10.8) 11 (21.2) 19 (16.8) 47 (21.5) 3 (18.8) 7 (13.7) 81 (19.1) Table 4. Antibiotic resistance of S. pneumoniae by regions. Antibiotic Central East West South North All Regions Penicillin (Meningitis) - 0.00% (0/1) 100.00% (2/2) 50.00% (1/2) 50.00% (1/2) 57.14% (4/7) Penicillin (Non-meningitis) 12.50% (2/16) 5.56% (4/72) 1.80% (2/111) 4.00% (2/50) 1.84% (4/217) 3.00% (14/466) Penicillin (Oral) 25.00% (4/16) 50.68% (37/73) 51.33% (58/113) 55.77% (29/52) 40.64% (89/219) 45.88% (217/473) Amoxicillin 18.75% (3/16) 9.59% (7/73) 23.89% (27/113) 23.08% (12/52) 13.70% (30/219) 16.70% (79/473) Cefaclor 31.25% (5/16) 69.86% (51/73) 73.45% (83/113) 63.46% (33/52) 59.82% (131/219) 64.06% (303/473) Cefuroxime 31.25% (5/16) 56.16% (41/73) 62.83% (71/113) 63.46% (33/52) 47.49% (104/219) 53.70% (254/473) Cefuroxime(Oral) 31.25% (5/16) 49.32% (36/73) 59.29% (67/113) 61.54% (32/52) 40.64% (89/219) 48.41% (229/473) Ceftriaxone (Non-meningitis) 12.50% (2/16) 15.28% (11/72) 13.51% (15/111) 20.00% (10/50) 16.13% (35/217) 15.67% (73/466) Ceftriaxone (Meningitis) - 0.00% (0/1) 50.00% (1/2) 0.00% (0/2) 50.00% (1/2) 28.57% (2/7) Vancomycin 0.00% (0/16) 0.00% (0/74) 0.00% (0/113) 0.00% (0/52) 0.00% (0/219) 0.00% (0/474) Erythromycin 93.75% (15/16) 97.30% (72/74) 94.69% (107/113) 88.00% (44/50) 94.04% (205/218) 94.06% (443/471) Azithromycin 93.75% (15/16) 97.26% (71/73) 92.04% (104/113) 78.85% (41/52) 94.52% (207/219) 92.60% (438/473) Clarithromycin 93.75% (15/16) 93.15% (68/73) 92.04% (104/113) 82.69% (43/52) 93.12% (203/218) 91.74% (433/472) Tetracycline 87.50% (14/16) 91.78% (67/73) 88.50% (100/113) 94.23% (49/52) 88.58% (194/219) 89.64% (424/473) Levofloxacin 0.00% (0/16) 2.70% (2/74) 1.77% (2/113) 3.85% (2/52) 2.74% (6/219) 2.53% (12/474) Moxifloxacin 0.00% (0/16) 0.00% (0/74) 0.00% (0/113) 0.00% (0/52) 0.91% (2/219) 0.42% (2/474) Trimethoprim-Sulfamethoxazole 68.75% (11/16) 65.75% (48/73) 65.49% (74/113) 51.92% (27/52) 52.29% (114/218) 58.05% (274/472) Chloramphenicol 12.50% (2/16) 8.11% (6/74) 10.62% (12/113) 5.77% (3/52) 7.76% (17/219) 8.44% (40/474) Clindamycin 93.75% (15/16) 97.26% (71/73) 89.38% (101/113) 67.31% (35/52) 88.53% (193/218) 87.92% (415/472) MDR 93.75% (15/16) 97.26% (71/73) 92.92% (105/113) 90.00% (45/50) 94.95% (207/218) 94.06% (443/471) Table 5. Antibiotic resistance of S. pneumoniae by disease category. Antibiotic Invasive Non-Invasive Number of Resistant strains Total Number Resistant Rate (%) Number of Resistant strains Total Number Resistant Rate (%) Penicillin (Meningitis) 4 7 57.14 0 0 - Penicillin (Non-meningitis) 1 44 2.27 13 422 3.08 Penicillin (Oral) 15 51 29.41 202 422 47.87 Amoxicillin 6 51 11.76 73 422 17.30 Cefaclor 25 51 49.02 278 422 65.88 Cefuroxime 20 51 39.22 234 422 55.45 Cefuroxime(Oral) 19 51 37.25 210 422 49.76 Ceftriaxone (Non-meningitis) 6 44 13.64 67 422 15.88 Ceftriaxone (Meningitis) 2 7 28.57 0 0 - Vancomycin 0 51 0.00 0 423 0.00 Erythromycin 48 51 94.12 395 420 94.05 Azithromycin 46 51 90.20 392 422 92.89 Clarithromycin 46 51 90.20 387 421 91.92 Tetracycline 49 51 96.08 375 422 88.86 Levofloxacin 2 51 3.92 10 423 2.36 Moxifloxacin 0 51 0.00 2 423 0.47 Trimethoprim-Sulfamethoxazole 25 51 49.02 249 421 59.14 Chloramphenicol 6 51 11.76 34 423 8.04 Clindamycin 42 51 82.35 373 421 88.60 MDR 47 51 92.16 396 420 94.29 Table 6. Antibiotic resistance of S. pneumoniae by vaccine types. Antibiotic PCV13 PCV15 PCV20 PCV21 PPV23 Penicillin (Meningitis) 50.00% 50.00% 25.00% 66.67% 25.00% Penicillin (Non-meningitis) 4.07% 4.01% 3.70% 2.98% 3.93% Penicillin (Oral) 56.57% 55.81% 54.27% 50.29% 51.78% Amoxicillin 25.25% 24.92% 23.17% 13.45% 23.62% Cefaclor 72.39% 71.43% 70.43% 68.42% 67.64% Cefuroxime 62.96% 62.13% 61.59% 57.31% 59.22% Cefuroxime(Oral) 57.91% 57.14% 56.40% 52.63% 54.37% Ceftriaxone (Non-meningitis) 23.05% 22.74% 20.99% 11.90% 21.31% Ceftriaxone (Meningitis) 50.00% 50.00% 25.00% 0.00% 25.00% Vancomycin 0.00% 0.00% 0.00% 0.00% 0.00% Erythromycin 94.61% 94.68% 94.82% 96.47% 94.50% Azithromycin 94.28% 94.35% 94.51% 93.57% 93.85% Clarithromycin 93.27% 93.36% 93.60% 94.15% 92.88% Tetracycline 90.91% 90.70% 91.46% 87.13% 91.26% Levofloxacin 2.68% 2.65% 2.43% 1.75% 2.58% Moxifloxacin 0.00% 0.00% 0.00% 0.58% 0.00% Trimethoprim-Sulfamethoxazole 63.64% 63.12% 64.33% 61.99% 62.78% Chloramphenicol 7.38% 7.95% 8.21% 11.70% 9.03% Clindamycin 91.25% 90.37% 90.24% 86.55% 89.32% MDR 95.29% 95.35% 95.43% 95.29% 94.82% Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6513636","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":450904479,"identity":"8a299558-efcb-41f8-add8-d8b0500a7f9e","order_by":0,"name":"Chunjiang Zhao","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chunjiang","middleName":"","lastName":"Zhao","suffix":""},{"id":450904480,"identity":"faee4836-34ba-47ba-8581-f65e79f30339","order_by":1,"name":"Feifei Zhang","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Feifei","middleName":"","lastName":"Zhang","suffix":""},{"id":450904481,"identity":"d6fa1b9d-4bb4-495c-b72c-6a2b1115d0b3","order_by":2,"name":"Zhanwei Wang","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhanwei","middleName":"","lastName":"Wang","suffix":""},{"id":450904482,"identity":"ac9a5d7a-76a0-46a4-a2a8-a2bbab234e95","order_by":3,"name":"Shuo Yang","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shuo","middleName":"","lastName":"Yang","suffix":""},{"id":450904483,"identity":"29a74a8a-1745-406c-8ebd-5a36564b14ee","order_by":4,"name":"Hongbin Chen","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hongbin","middleName":"","lastName":"Chen","suffix":""},{"id":450904484,"identity":"68374587-7947-421d-95c6-8c3e757b48dc","order_by":5,"name":"Hui Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAp0lEQVRIiWNgGAWjYDACCQaGwww8Njz8/A2kaUmTkZxxgAQtzEBdNgYNCUTqMLjdY3i4QOY8jwHDAcYPH3OI0XLnjMHhGTy3ecyZG5glZ24jQovZjRyDwzxALZYNB9iYeUnQco7H4EACaVoOkKDF/kZaAdAvyTySMw42E+cXyRnJmz8X9tjZ8/M3H/zwkRgtYMDYAyYbiFUPAj9IUTwKRsEoGAUjDgAAPSE2aRb/dpEAAAAASUVORK5CYII=","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hui","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-04-23 14:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6513636/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6513636/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-025-11377-5","type":"published","date":"2025-08-05T15:56:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82175930,"identity":"dcb6fd1c-9312-4516-8829-7ad3e0eed665","added_by":"auto","created_at":"2025-05-07 11:10:59","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50067,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of 20 general hospitals included in the study\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6513636/v1/dacd953b3e5e06f345fe2705.jpg"},{"id":82175927,"identity":"02cfe954-09e0-4421-af17-44b5c3cd52c8","added_by":"auto","created_at":"2025-05-07 11:10:59","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":44147,"visible":true,"origin":"","legend":"\u003cp\u003eSerotype distribution of \u003cem\u003eS.p\u003c/em\u003e isolates\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6513636/v1/e6a272fdb1f22b3b64ed84ad.jpg"},{"id":82177139,"identity":"795e7692-1073-4fc0-b063-3a36e84737f2","added_by":"auto","created_at":"2025-05-07 11:18:59","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":47948,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 2. Serotype distribution of \u003cem\u003eS.p\u003c/em\u003e isolates\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6513636/v1/bc3d65847958888f07ddc24b.jpg"},{"id":82177140,"identity":"551f3645-7c97-4ac7-9fdd-6167a0f044ba","added_by":"auto","created_at":"2025-05-07 11:18:59","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":72490,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3. Antibiotic resistance of \u003cem\u003eS. pneumoniae \u003c/em\u003eby regions.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6513636/v1/e8add14f3dd68b59c3a1fee5.jpg"},{"id":82175928,"identity":"4ba91379-3360-4bf5-a0fe-a94e8556e7ee","added_by":"auto","created_at":"2025-05-07 11:10:59","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":54974,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 4. Antibiotic resistance of \u003cem\u003eS. pneumoniae \u003c/em\u003eby disease category.\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6513636/v1/47c18fca4ee2c5ea2f372507.jpg"},{"id":82175931,"identity":"33ead8af-5298-435b-82bd-be15b31ba56f","added_by":"auto","created_at":"2025-05-07 11:10:59","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":117857,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 5. Antibiotic resistance of \u003cem\u003eS. pneumoniae \u003c/em\u003eby vaccine types.\u003c/p\u003e","description":"","filename":"6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6513636/v1/1141e369dda9a338369b92b2.jpg"},{"id":88814070,"identity":"e56c1f44-db12-45a0-998c-f1f376cc57c4","added_by":"auto","created_at":"2025-08-11 16:06:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1988763,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6513636/v1/bb686135-f1e8-4ea1-ab3f-cd8564af3431.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Distribution of serotypes and antibiotic resistance profiles of Streptococcus pneumoniae in hospitalized adult patients: A retrospective multicenter surveillance in China (2018-2019)","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e (\u003cem\u003eS. pneumoniae\u003c/em\u003e) is a leading bacterial cause of community acquired pneumonia (CAP), bacteremia, and meningitis worldwide (1). Although all ages groups are affected, pneumococcal disease significantly affects young children and the elderly, as well as individuals with certain chronic disease and immunocompromising conditions (2). Globally, pneumococcal-related respiratory infections are associated with a high mortality burden among adults aged over 70 years, with an estimated rate of 44.2 deaths per 100,000 population (3).\u003c/p\u003e\n\u003cp\u003eIn China, \u003cem\u003eS. pneumoniae\u003c/em\u003e is an important pathogen for morbidity and mortality among children and older adults, and pneumococcal disease cases in China account for 12% of the total pneumococcal cases worldwide (4). Pneumococcal infections are estimated to cause approximately 89,593 deaths annually among adults older than 70 years in China, with a mortality rate of 82.98 per 100,000 population (5).\u003c/p\u003e\n\u003cp\u003ePneumococcal infections are treated with antibiotics, however, treatment may be complicated by the resistance to antibiotic therapies. \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates from adult patients show high resistance rates to common antibiotics in 2012-2017 (erythromycin, 90.8%, cefuroxime, 58.9%, and ceftriaxone 22.2%). In addition, a high multidrug resistance (MDR) rate was also observed (76.0%) (6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eImmunization with vaccines against \u003cem\u003eS. pneumoniae\u003c/em\u003e is the most effective public health measure for the prevention of pneumococcal infections. Available pneumococcal vaccines in China include a 23-valent pneumococcal polysaccharide vaccine (PPV23) and a 13-valent pneumococcal conjugate vaccine (PCV13). PPV23 is indicated for use in children aged 2 years or older and in adults (8). The 7-valent pneumococcal conjugate vaccine (PCV7), targeting serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F, was first licensed in China in 2008 for pediatric immunization. Building on the same conjugation technology, PCV13 expanded coverage to include six additional serotypes (1, 3, 5, 6A, 7F, and 19A) and received regulatory approval in China in 2016, however, exclusively to pediatric populations (9, 10). More than 100 distinct \u003cem\u003eS. pneumoniae\u003c/em\u003e serotypes have been identified based on capsular polysaccharide structure, underscoring the complexity of vaccine development (7). Globally, Multiple countries have introduced PCVs into their national immunization programs for infants and children. Following the implementation of PCVs in these programs, substantial reductions in IPD, pneumonia, and otitis media have been observed in vaccinated children (11-13), as well as in adults through herd immunity (14). There is a need to directly protect the adults via PCV despite herd protection, therefore, PCV20 and PCV21 were both registered and recommended for adults since 2022, and now are scaling up worldwide (15). PPV23 vaccination among adults has been shown to effectively alleviate invasive pneumococcal diseases (IPD) burden in adults.(16, 17)\u003c/p\u003e\n\u003cp\u003eThis study was designed to investigate the distribution of pneumococcal serotypes and antimicrobial susceptibility of \u003cem\u003eS. pneumoniae\u0026nbsp;\u003c/em\u003e(2018-2019) to commonly used antimicrobial agents among Chinese adult patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBacterial isolates\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 474 \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates were collected from adult patients with pneumococcal infections in 14 cities across 5 regions (North, South, East, West, and Central) of China between 2018 and 2019. The study protocols were approved by Ethics Committee of the Pecking University People\u0026rsquo;s Hospital and all participants provided written informed consent prior to study commencement. One isolate was collected from each patient. Duplicate isolates and patients colonized by bacteria but without any clinical evidence of infection were excluded. Isolates were obtained from sputum, blood, broncho-alveolar lavage fluid (BALF), cerebrospinal fluid (CSF), pharyngeal swabs, nasal swabs, and middle ear fluid, etc. \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates from sputum were included if they met the following criteria: less than 10 squamous epithelial cells and more than 25 leukocytes per low power field. Isolates were transported to Peking University People\u0026rsquo;s Hospital for antibiotic susceptibility testing and serotyping annually. Isolates were identified based on typical colony morphology, Gram staining, optochin sensitivity tests (Oxoid, Hampshire, UK), and Omni serum assays (Statens Serum Institut, Copenhagen, Denmark).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIn vitro antimicrobial susceptibility testing\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe agar dilution method was used to determine the minimum inhibitory concentrations (MICs) of the 474 \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates against 15 antibiotics (penicillin, amoxicillin/clavulanic acid, ceftriaxone, cefuroxime, cefaclor, vancomycin, erythromycin, azithromycin, clarithromycin, tetracycline, levofloxacin, moxifloxacin, trimethoprim/ sulfamethoxazole, chloramphenicol and clindamycin) in accordance with the guidelines established by the Clinical and Laboratory Standards Institute (CLSI). The CLSI 2023 criteria for MICs were applied to classify isolates as susceptible, intermediate, or resistant (18). The oral penicillin breakpoint was used to classify isolates as penicillin susceptible (MIC\u0026nbsp;\u0026le;0.06\u0026nbsp;\u0026mu;g/ml), penicillin-intermediate (MIC between 0.12 and 1\u0026nbsp;\u0026mu;g/ml), or penicillin-resistant (MIC\u0026nbsp;\u0026ge;2\u0026nbsp;\u0026mu;g/ml). For ceftriaxone, the non-meningitis breakpoint was used to classify isolates as susceptible (MIC\u0026nbsp;\u0026le;1\u0026nbsp;\u0026mu;g/ml) or resistant (MIC\u0026nbsp;\u0026ge;4\u0026nbsp;\u0026mu;g/ml) (17). \u003cem\u003eS. pneumoniae\u0026nbsp;\u003c/em\u003eATCC 49619 was used as the quality control strain and was included in each set of tests to ensure accurate results. Multidrug-resistant (MDR) \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates were defined as isolates that were resistant to \u0026ge;3 classes of antimicrobial agents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePneumococcal serotyping\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePneumococcal serotypes/groups were determined for the 474 isolates with Pneumotest-Latex kit (Statens Serum Institut, Copenhagen, Denmark) and type-specific antisera (Statens Serum Institut, Copenhagen, Denmark). The Pneumotest-Latex kit consisted of the 14 latex reagents pools A-I and P-Q. By testing all 14 pools and using the chessboard identification system, it was possible to identify the 23 vaccine serotypes to type/group level. Traditional quellung reaction with type-specific antisera was used for full serotyping of serogroup 19, 6 and 23. The coverages of PCV13, PCV15, PCV20, PCV21 and PPV23 vaccines were estimated by calculating the percentage of isolates that expressed the serotypes included in the vaccines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive, non-comparative analysis was used in this study. Frequency distributions that provided the number and percentage of pneumococcal isolates per serotype were calculated for all serotypes identified in this study. Serotypes were grouped by PCV13, PCV15, PCV20, PCV21 and PPV23 coverage. Breakdowns of serotypes by age groups (18-49, 50-59, 60-69, \u0026ge;70) for above serotype distribution were also presented.\u003c/p\u003e\n\u003cp\u003eThe number and percentage of susceptible, intermediate, and resistant serotypes of \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates were calculated. Overall frequency distribution of susceptible, intermediate, and resistant serotypes was given for each antibiotic. The data were analyzed using the R software (version 4.4.2).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCharacteristics of pneumococcal isolates\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the study period, a total of 474 \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates were collected, with 66.9% derived from male patients and 33.1% from females. Patients aged 70 years and older accounted for the largest proportion (35.7%) among all age groups. Most isolates were obtained from non-invasive specimens (89.2%), while 10.8% were from invasive sources such as blood and cerebrospinal fluid. Geographically, most isolates were collected from northern China (46.2%), followed by the western (23.9%), eastern (15.6%), southern (11.0%), and central (3.4%) regions (Table 1, Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSerotype distribution\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe serotype distribution of the isolates is presented in Table 2. Overall, serotype 19F was the most prevalent (24.9%), followed by 19A (10.3%), 23F (9.5%), 6A (5.9%), and 15A (5.3%) (Figure 2). Across all age groups, 19F remained the predominant serotype, ranging from 16.9% (50-59 years) to 30.2% (\u0026ge;70 years). Similarly, 19F was the most prevalent serotype across all geographic regions, ranging from 22.4% (northern) to 31.2% (central). In the eastern and western regions, 19A was the second most common serotype, accounting for 16.2% and 13.3% of isolates, respectively, whereas in the southern, northern, and central regions, 23F ranked second (13.5%, 9.6%, and 12.5%, respectively). Serotype 19F maintained dominance in both invasive and non-invasive specimens, with respective prevalence rates of 27.5% and 24.6%. Notably, among invasive isolates, serotype 6A (11.8%) emerged as the secondary variant, closely trailing 19F. A parallel pattern was observed in older adults (60-69 years), where 19F retained prominence at 16.9%, while 6A constituted the second most prevalent serotype (11.3%).\u003c/p\u003e\n\u003cp\u003eVaccine coverage across different groups is presented in Table 3. Among all isolates, PCV20 demonstrated the highest overall coverage (69.4%), followed by PPV23 (65.4%), PCV15 (MSD) (63.7%), and PCV13 (62.9%). PCV21 had the lowest coverage (36.1%), while 18.6% of isolates were not covered by any of the evaluated vaccines. Across all age groups, PCV20 consistently showed the highest coverage, ranging from 67.6% (60-69 years) to 72.5% (50-59 years). Regionally, PCV20 had the highest coverage in all areas except the central region, where PPV23 coverage (75.0%) was the highest. Similarly, PCV20 demonstrated the greatest coverage in both invasive (80.4%) and non-invasive (68.1%) specimens.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAntibiotic Resistance Profiles of S. pneumoniae across Regions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAntibiotic resistance among \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates from hospitalized adult patients in China was notably high, with multidrug resistance (MDR) detected in 94.06% of cases (Figure 3). Resistance to macrolides was particularly widespread, with over 90% of isolates exhibiting resistance to erythromycin, azithromycin, and clarithromycin. Similarly, high resistance rates were observed for tetracycline (89.64%) and clindamycin (87.92%). Penicillin resistance was 57.14% in meningitis cases and 45.81% in oral treatment cases. Ceftriaxone resistance was lower, with 28.57% for meningitis and 15.67% for non-meningitis cases. Trimethoprim-sulfamethoxazole resistance was moderate (58.05%), while resistance to amoxicillin (16.70%) and chloramphenicol (8.44%) was relatively low. Fluoroquinolone resistance was rare, and no vancomycin resistance was detected.\u003c/p\u003e\n\u003cp\u003eRegional variations were evident in antibiotic resistance patterns. Macrolide and tetracycline resistance were consistently high across all regions, while \u0026beta;-lactam resistance varied. Notably, the East and West regions exhibited higher resistance rates for several antibiotics, whereas resistance to ceftriaxone (meningitis) was lowest in the East and highest in the West. Chloramphenicol resistance was highest in the Central region. The detailed distribution of antibiotic resistance rates across different regions is shown in Table 4. The comparison of antibiotic resistance profiles between invasive and non-invasive isolates is summarized in Table 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAntibiotic Resistance Profiles of S. pneumoniae by Vaccine Types\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAntibiotic resistance patterns differed between invasive and non-invasive \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates (Figure 4). Overall, multidrug resistance (MDR) was highly prevalent in both groups, with slightly higher resistance rates observed in non-invasive isolates (94.29%) compared to invasive isolates (92.16%). Resistance to macrolides, including erythromycin, azithromycin, and clarithromycin, was consistently high, exceeding 90% in both invasive and non-invasive isolates. Tetracycline resistance was also substantial, reaching 96.08% in invasive isolates and 91.92% in non-invasive isolates. Clindamycin resistance followed a similar trend, with rates of 82.35% and 88.60% in invasive and non-invasive isolates, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor \u0026beta;-lactam antibiotics, cefaclor resistance was higher in non-invasive isolates (65.88%) than in invasive isolates (49.02%). Trimethoprim-sulfamethoxazole resistance was similar between the two groups (49.02% vs. 59.14%). Resistance to penicillin varied by clinical syndrome, with meningitis-associated strains showing higher resistance (57.14% in invasive isolates and 55.45% in non-invasive isolates) compared to non-meningitis-associated strains (2.27% and 3.08%, respectively). Third-generation cephalosporin resistance was relatively lower, with cefuroxime resistance at 39.22% (invasive) and 49.76% (non-invasive), and ceftriaxone resistance for meningitis cases at 28.57% (invasive) and 47.87% (non-invasive). Fluoroquinolone resistance remained low, with levofloxacin resistance below 5% and moxifloxacin resistance nearly absent. Vancomycin resistance was not detected in any isolate.\u003c/p\u003e\n\u003cp\u003eWhen stratified by vaccine serotype coverage, resistance rates varied across pneumococcal vaccines (PCV13, PCV15, PCV20, PCV21, and PPV23) (Figure 5). Serotypes covered by the higher-valency vaccines (PCV20 and PCV21) tended to exhibit higher resistance to macrolides, tetracyclines, and clindamycin, suggesting that resistant strains are more likely to be found within these serotypes. Penicillin resistance, particularly in meningitis-associated strains, remained moderate among serotypes covered by different vaccine formulations, while resistance to fluoroquinolones and vancomycin was consistently low across all vaccine serotype groups. Antibiotic resistance patterns among isolates stratified by vaccine coverage (PCV13, PCV15, PCV20, PCV21, PPV23) are presented in Table 6.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this multicenter study conducted in China, we evaluated the serotype distribution and antimicrobial susceptibility of \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates cultured from adult patients. A total of 474 pneumococcal isolates were obtained, with serotype 19F being the most prevalent (24.9%), followed by 19A (10.3%), 23F (9.5%) and 6A (5.9%), consistent with findings from previous studies conducted in China (19). The predominance of serotype 19F across age groups, geographic regions, and specimen sources observed in this study highlights its continued circulation in the adult population in China. However, our results differ from those reported in other regions, as recent studies have highlighted notable geographic variation in pneumococcal serotype distribution. For instance, the predominant serotypes identified in the United States include 3, 22F, 19A, 35B, 9N, and 19F, in Korea, serotypes 3, 10A, 19A, and 23A are most frequently observed, whereas in Japan, 35B, 11A, and 3 are the most common (20-23). One multi-center study from 2009 to 2015 when the PCV13 (including serotype 3) was not available in China reported that serotype 3 was the most predominant serotype (21.7%), followed by 19F, 19 A and 23F. However, we have not yet identify any studies with serotype 3 as a top serotype since the launch of PCV13 in China (23).\u003c/p\u003e\n\u003cp\u003eWith regard to vaccine coverage, PCV20 provided the highest overall coverage (69.4%) among all evaluated vaccines and consistently outperformed other formulations across all age groups and regions, except in the central region where PPV23 showed slightly higher coverage (75.0%). Notably, PCV20 also demonstrated the greatest coverage in both invasive and non-invasive isolates, suggesting its potential utility in broader adult immunization strategies. Similar to our findings, a study from Turkey reported that among adults aged 18-64 years, serotype coverage rates were 62.8% for PCV13, 65.1% for PCV15, 71.0% for PCV20, and 74.3% for PPV23. In adults aged \u0026ge;65 years, the corresponding coverage rates were 66.0%, 69.5%, 80.1%, and 78.7%, respectively (24).\u003c/p\u003e\n\u003cp\u003eOur study highlights the extensive antibiotic resistance among \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates from hospitalized adult patients in China, with particularly high rates of MDR and significant regional and strain-specific variations. These findings emphasize the urgent need for improved antimicrobial stewardship and vaccination strategies to mitigate the burden of antibiotic-resistant pneumococcal infections.\u003c/p\u003e\n\u003cp\u003eThe observed MDR prevalence of 94.06% aligns with previous reports of high resistance rates in Asia (25). Macrolide resistance exceeding 90% for erythromycin, azithromycin, and clarithromycin suggests widespread dissemination of resistance determinants, likely driven by the overuse of these antibiotics in outpatient settings (26). Tetracycline (89.64%) and clindamycin (87.92%) resistance further reflect the impact of selective pressure from commonly prescribed antibiotics (27). Conversely, low fluoroquinolone resistance and absence of vancomycin resistance provide critical insights into potential treatment options for severe pneumococcal infections (28).\u003c/p\u003e\n\u003cp\u003eThe substantial variation in resistance rates across regions suggests distinct antibiotic prescribing practices and potential differences in circulating pneumococcal lineages. The East and West regions demonstrated higher resistance to\u0026nbsp;\u0026beta;-lactam antibiotics, which may reflect differences in healthcare infrastructure, antibiotic use regulations, and local epidemiology. Notably, ceftriaxone resistance was lowest in the East and highest in the West, highlighting potential geographic disparities in treatment efficacy.\u003c/p\u003e\n\u003cp\u003eMDR was slightly higher in non-invasive isolates (94.29%) compared to invasive isolates (92.16%), consistent with prior findings (29). Unlike invasive isolates, which primarily cause bloodstream and cerebrospinal infections, non-invasive strains colonize the nasopharynx and are frequently exposed to subtherapeutic antibiotic levels, promoting horizontal gene transfer of resistance determinants (30). Additionally, non-invasive pneumococcal strains often carry mobile genetic elements, such as transposons and plasmids, facilitating the acquisition of resistance genes (Cohen et al., 2019). Resistance patterns differed by syndrome, with higher penicillin resistance in meningitis-associated strains, particularly in invasive isolates (57.14%). This could be due to the limited penetration of \u0026beta;-lactam antibiotics into the cerebrospinal fluid (CSF), leading to subtherapeutic drug concentrations that select for resistant strains. Additionally, meningitis-associated strains often belong to hypervirulent, multidrug-resistant clones that harbor penicillin-binding protein (PBP) mutations, further reducing \u0026beta;-lactam efficacy. The relatively lower resistance to third-generation cephalosporins (ceftriaxone and cefuroxime) suggests their continued role in treatment, albeit with caution due to rising resistance trends.\u003c/p\u003e\n\u003cp\u003eSerotype-specific resistance patterns indicate that strains covered by higher-valency pneumococcal vaccines (PCV20) exhibited greater macrolide, tetracycline, and clindamycin resistance, suggesting that antibiotic-resistant pneumococcal serotypes are more prevalent within vaccine-covered groups. This finding underscores the need for continued surveillance to assess the impact of serotype replacement and vaccine effectiveness in reducing antibiotic-resistant pneumococcal infections.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eApproved by the Ethics Committee of Peking University People's Hospital, approval No. 2018PHB129.\u003c/p\u003e\n\u003cp\u003eClinical trial \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eConsent for publication \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAuthors’ contributions \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eH.W. and C.Z. contributed to study design and data acquisition. Z.W. F.Z. and S.Y. performed microbiological testing. H.C. analyzed the data and prepared figures. H.W. and C.Z. drafted the manuscript. All authors (C.Z., F.Z., Z.W., S.Y., H.C., and H.W.) reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe thank the participating hospitals and laboratory staff for their contributions to specimen collection and analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWeiser JN, Ferreira DM, Paton JC. Streptococcus pneumoniae: transmission, colonization and invasion. Nat Rev Microbiol. 2018,16(6):355-67.\u003c/li\u003e\n\u003cli\u003eWahl B, O\u0026apos;Brien KL, Greenbaum A, Majumder A, Liu L, Chu Y, et al. Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15. The Lancet Global health. 2018,6(7):e744-e57.\u003c/li\u003e\n\u003cli\u003eYu X, Wang H, Ma S, Chen W, Sun L, Zou Z. Estimating the global and regional burden of lower respiratory infections attributable to leading pathogens and the protective effectiveness of immunization programs. Int J Infect Dis. 2024,149:107268.\u003c/li\u003e\n\u003cli\u003eChe D, Zhou H, He J, Wu B. Modeling the impact of the 7-valent pneumococcal conjugate vaccine in Chinese infants: an economic analysis of a compulsory vaccination. BMC Health Serv Res. 2014,14:56.\u003c/li\u003e\n\u003cli\u003eKang L, Jing W, Liu Q, Liu J, Liu M. The trends of mortality, aetiologies and risk factors of lower respiratory infections in China from 1990 to 2019: Findings from the Global Burden of Disease Study 2019. J Infect Public Health. 2022,15(8):870-6.\u003c/li\u003e\n\u003cli\u003eKim SH, Chung DR, Song J-H, Baek JY, Thamlikitkul V, Wang H, et al. Changes in serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates from adult patients in Asia: Emergence of drug-resistant non-vaccine serotypes. Vaccine. 2020,38(38):6065-73.\u003c/li\u003e\n\u003cli\u003eGanaie F, Saad JS, McGee L, van Tonder AJ, Bentley SD, Lo SW, et al. A New Pneumococcal Capsule Type, 10D, is the 100th Serotype and Has a Large cps Fragment from an Oral Streptococcus. mBio. 2020,11(3).\u003c/li\u003e\n\u003cli\u003eDouglas RM, Miles HB. Vaccination against Streptococcus pneumoniae in childhood: lack of demonstrable benefit in young Australian children. The Journal of infectious diseases. 1984,149(6):861-9.\u003c/li\u003e\n\u003cli\u003eBoulton ML, Ravi NS, Sun X, Huang Z, Wagner AL. Trends in childhood pneumococcal vaccine coverage in Shanghai, China, 2005\u0026ndash;2011: a retrospective cohort study. BMC Public Health. 2015,16:109.\u003c/li\u003e\n\u003cli\u003eZhao C, Zhang F, Chu Y, Liu Y, Cao B, Chen M, et al. Phenotypic and Genotypic Characteristic of Invasive Pneumococcal Isolates from Both Children and Adult Patients from a Multicenter Surveillance in China 2005\u0026ndash;2011. PLoS ONE. 2013,8(12):e82361.\u003c/li\u003e\n\u003cli\u003ePilishvili T, Lexau C, Farley MM, Hadler J, Harrison LH, Bennett NM, et al. Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. The Journal of infectious diseases. 2010,201(1):32-41.\u003c/li\u003e\n\u003cli\u003eWasserman M, Chapman R, Lapidot R, Sutton K, Dillon-Murphy D, Patel S, et al. Twenty-Year Public Health Impact of 7- and 13-Valent Pneumococcal Conjugate Vaccines in US Children. Emerg Infect Dis. 2021,27(6):1627-36.\u003c/li\u003e\n\u003cli\u003eRose M, Zielen S. Impact of infant immunization programs with pneumococcal conjugate vaccine in Europe. Expert Rev Vaccines. 2009,8(10):1351-64.\u003c/li\u003e\n\u003cli\u003eKim YA-O, LaFon DA-O, Nahm MH. Indirect Effects of Pneumococcal Conjugate Vaccines in National Immunization Programs for Children on Adult Pneumococcal Disease. (2093-2340 (Print)).\u003c/li\u003e\n\u003cli\u003eKobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices \u0026mdash; United States, 2022. MMWR Morb Mortal Wkly Rep 2022,71:109\u0026ndash;117.\u003c/li\u003e\n\u003cli\u003eDjennad A, Ramsay ME, Pebody R, Fry NK, Sheppard C, Ladhani SN, et al. Effectiveness of 23-Valent Polysaccharide Pneumococcal Vaccine and Changes in Invasive Pneumococcal Disease Incidence from 2000 to 2017 in Those Aged 65 and Over in England and Wales. EClinicalMedicine. 2018,6:42-50.\u003c/li\u003e\n\u003cli\u003ePerniciaro S, van der Linden M. Pneumococcal vaccine uptake and vaccine effectiveness in older adults with invasive pneumococcal disease in Germany: A retrospective cohort study. Lancet Reg Health Eur. 2021,7:100126.\u003c/li\u003e\n\u003cli\u003e(CLSI) CaLSI. Performance standards for antimicrobial susceptibility testing, thirty-third informational supplement. \u003cstrong\u003eWayne\u003c/strong\u003e: CLSI, 2023. Report No.: M100-Ed33 \u003c/li\u003e\n\u003cli\u003eZhao C, Li Z, Zhang F, Zhang X, Ji P, Zeng J, et al. Serotype distribution and antibiotic resistance of Streptococcus pneumoniae isolates from 17 Chinese cities from 2011 to 2016. BMC Infect Dis. 2017,17(1):804.\u003c/li\u003e\n\u003cli\u003eSelf WH, Johnson KD, Resser JJ, Whitney CG, Baughman A, Kio M, et al. Prevalence, Clinical Severity, and Serotype Distribution of Pneumococcal Pneumonia Among Adults Hospitalized With Community-Acquired Pneumonia in Tennessee and Georgia, 2018-2022. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2024,79(4):838-47.\u003c/li\u003e\n\u003cli\u003eMiyazaki T, van der Linden M, Hirano K, Maeda T, Kohno S, Gonzalez EN, et al. Serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae isolates cultured from Japanese adult patients with community-acquired pneumonia in Goto City, Japan. Front Microbiol. 2024,15:1458307.\u003c/li\u003e\n\u003cli\u003eKim GR, Kim EY, Kim SH, Lee HK, Lee J, Shin JH, et al. Serotype Distribution and Antimicrobial Resistance of Streptococcus pneumoniae Causing Invasive Pneumococcal Disease in Korea Between 2017 and 2019 After Introduction of the 13-Valent Pneumococcal Conjugate Vaccine. Ann Lab Med. 2023,43(1):45-54.\u003c/li\u003e\n\u003cli\u003eHascelik G, Soyletir G, Gulay Z, Sancak B, Yaman A, Gurler N, et al. Serotype distribution of Streptococcus pneumoniae and pneumococcal vaccine coverage in adults in Turkey between 2015 and 2018. Ann Med. 2023,55(1):266-75.\u003c/li\u003e\n\u003cli\u003eLi MC, Wang Y, Zhang H, Liu Y, Chen XJ, et al. Serotype distribution and clinical characteristics associated with streptococcus pneumoniae among Chinese children and adults with invasive pneumococcal disease: a multicenter observational study. Hum Vaccin Immunother. 2021 Jan 2,17(1):146-156. doi: 10.1080/21645515.2020.1757996. Epub 2020 Jun 12. PMID: 32530720, PMCID: PMC7872053.\u003c/li\u003e\n\u003cli\u003eKim L, McGee L, Tomczyk S, Beall B. Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective. Clinical microbiology reviews. 2016,29(3):525-52.\u003c/li\u003e\n\u003cli\u003eSchroeder MR, Stephens DS. Macrolide Resistance in Streptococcus pneumoniae. Front Cell Infect Microbiol. 2016,6:98.\u003c/li\u003e\n\u003cli\u003eBarkai G, Greenberg D, Givon-Lavi N, Dreifuss E, Vardy D, Dagan R. Community prescribing and resistant Streptococcus pneumoniae. Emerg Infect Dis. 2005,11(6):829-37.\u003c/li\u003e\n\u003cli\u003eRodriguez CA, Atkinson R, Bitar W, Whitney CG, Edwards KM, Mitchell L, et al. Tolerance to vancomycin in pneumococci: detection with a molecular marker and assessment of clinical impact. J Infect Dis. 2004,190(8):1481-7.\u003c/li\u003e\n\u003cli\u003eHiggs C, Kumar LS, Stevens K, Strachan J, Korman T, Horan K, et al. Comparison of contemporary invasive and non-invasive Streptococcus pneumoniae isolates reveals new insights into circulating anti-microbial resistance determinants. Antimicrob Agents Chemother. 2023,67(11):e0078523.\u003c/li\u003e\n\u003cli\u003eNielsen KL, Hammerum AM, Lambertsen LM, Lester CH, Arpi M, Knudsen JD, et al. Characterization and transfer studies of macrolide resistance genes in Streptococcus pneumoniae from Denmark. Scand J Infect Dis. 2010,42(8):586-93.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Characteristics of patients with collected \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e66.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eAge group (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003e18-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003e\u0026ge;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eSpecimen source\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eNon-invasive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e89.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eSputum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e70.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eBronchoalveolar lavage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eNose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eSecretions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eBrush\u0026nbsp;biopsy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eSinus\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003ePus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eUrine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eDrainage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eEar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eThroat swab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eInvasive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eBlood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eCerebrospinal\u0026nbsp;fluid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eEye (Sterile)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003ePleural fluid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eRegion (city, province)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eEast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eDong\u0026apos;a\u0026nbsp;County\u0026nbsp;People\u0026apos;s\u0026nbsp;Hospital (Dong\u0026rsquo;a, Shandong)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eShandong Provincial Hospital (Jinan, Shandong)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eTaian Central Hospital (Taian, Shandong)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eSouth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003e\u0026nbsp; Guangzhou Institute of Respiratory Health (Guangzhou, Guangdong)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eLiuzhou People\u0026apos;s Hospital (Liuzhou, Guangxi)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eLiuzhou Maternal and Child Health Hospital (Liuzhou, Guangxi)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eThe First Affiliated Hospital of Sun Yat-sen University (Guangzhou, Guangdong)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eWest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003e\u0026nbsp; Ningxia Medical University General Hospital (Yinchuan, Ningxia)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eThe\u0026nbsp;Third\u0026nbsp;Hospital\u0026nbsp;of\u0026nbsp;Mianyang (Mianyang, Sichuan)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eWest\u0026nbsp;China\u0026nbsp;Hospital\u0026nbsp;of\u0026nbsp;Sichuan\u0026nbsp;University (Chengdu, Sichuan)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eXijing\u0026nbsp;Hospital (Xian, Shannxi)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eNorth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eBeijing\u0026nbsp;Tsinghua\u0026nbsp;Chang\u0026nbsp;Gung\u0026nbsp;Memorial\u0026nbsp;Hospital (Beijing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eBeijing Chaoyang\u0026nbsp;Hospital (Beijing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eChina-Japan\u0026nbsp;Friendship\u0026nbsp;Hospital (Beijing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eChina\u0026nbsp;Medical\u0026nbsp;University\u0026nbsp;Shengjing\u0026nbsp;Hospital (Shenyang, Liaoning)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eJilin\u0026nbsp;University\u0026nbsp;Sino-Japanese\u0026nbsp;Friendship\u0026nbsp;Hospital (Changchun, Jilin)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003ePeking\u0026nbsp;University\u0026nbsp;People\u0026apos;s\u0026nbsp;Hospital (Beijing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eCentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eWuhan\u0026nbsp;Fourth\u0026nbsp;Hospital (Wuhan, Hubei)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eXiangya\u0026nbsp;Hospital\u0026nbsp;Central\u0026nbsp;South\u0026nbsp;University (Changsha, Hunan)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 444px;\"\u003e\n \u003cp\u003eHunan Provincial People\u0026apos;s Hospital (Changsha, Hunan)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"95%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"15\" style=\"width: 100px;\"\u003e\n \u003cp\u003eTable 2. Serotype distribution of\u003cem\u003e\u0026nbsp;S.pneumoniae\u003c/em\u003e [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003eSerotype\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n=474)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 27px;\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 32px;\"\u003e\n \u003cp\u003eRegion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 18px;\"\u003e\n \u003cp\u003eSpecimen source\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e18-49\u003c/p\u003e\n \u003cp\u003e(n=72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003cp\u003e(n=91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003cp\u003e(n=142)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026ge;70\u003c/p\u003e\n \u003cp\u003e(n=169)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eEast\u003c/p\u003e\n \u003cp\u003e(n=74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eSouth\u003c/p\u003e\n \u003cp\u003e(n=52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eWest\u003c/p\u003e\n \u003cp\u003e(n=113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNorth\u003c/p\u003e\n \u003cp\u003e(n=219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eCentral\u003c/p\u003e\n \u003cp\u003e(n=16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eInvasive\u003c/p\u003e\n \u003cp\u003e(n=51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eNon-invasive\u003c/p\u003e\n \u003cp\u003e(n=423)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eVaccine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7\u003cbr\u003e\u0026nbsp;(1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e4\u003cbr\u003e\u0026nbsp;(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e4\u003cbr\u003e\u0026nbsp;(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e6\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e6A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e28\u003cbr\u003e\u0026nbsp;(5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7\u003cbr\u003e\u0026nbsp;(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e16\u003cbr\u003e\u0026nbsp;(11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3\u003cbr\u003e\u0026nbsp;(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n 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style=\"width: 10px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e20\u003cbr\u003e\u0026nbsp;(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e4\u003cbr\u003e\u0026nbsp;(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7\u003cbr\u003e\u0026nbsp;(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7\u003cbr\u003e\u0026nbsp;(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n 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style=\"width: 11px;\"\u003e\n \u003cp\u003e17F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n 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style=\"width: 8px;\"\u003e\n \u003cp\u003e6\u003cbr\u003e\u0026nbsp;(11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e43\u003cbr\u003e\u0026nbsp;(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e19F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e118\u003cbr\u003e\u0026nbsp;(24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e16\u003cbr\u003e\u0026nbsp;(22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e27\u003cbr\u003e\u0026nbsp;(29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e24\u003cbr\u003e\u0026nbsp;(16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e51\u003cbr\u003e\u0026nbsp;(30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n 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\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e8\u003cbr\u003e\u0026nbsp;(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e23B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e6\u003cbr\u003e\u0026nbsp;(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3\u003cbr\u003e\u0026nbsp;(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e4\u003cbr\u003e\u0026nbsp;(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e5\u003cbr\u003e\u0026nbsp;(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e23F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e45\u003cbr\u003e\u0026nbsp;(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e11 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e8\u003cbr\u003e\u0026nbsp;(8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e14\u003cbr\u003e\u0026nbsp;(9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e12\u003cbr\u003e\u0026nbsp;(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e5\u003cbr\u003e\u0026nbsp;(6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7\u003cbr\u003e\u0026nbsp;(13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e10\u003cbr\u003e\u0026nbsp;(8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e21\u003cbr\u003e\u0026nbsp;(9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e43\u003cbr\u003e\u0026nbsp;(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e33F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3\u003cbr\u003e\u0026nbsp;(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3\u003cbr\u003e\u0026nbsp;(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e35B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eNon-vaccine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n 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style=\"width: 11px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e8\u003cbr\u003e\u0026nbsp;(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e5\u003cbr\u003e\u0026nbsp;(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n 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style=\"width: 8px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3\u003cbr\u003e\u0026nbsp;(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e17A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n 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style=\"width: 10px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e35A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n 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style=\"width: 11px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e6\u003cbr\u003e\u0026nbsp;(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3\u003cbr\u003e\u0026nbsp;(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e6\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e47A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e47F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e4\u003cbr\u003e\u0026nbsp;(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2\u003cbr\u003e\u0026nbsp;(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4\u003cbr\u003e\u0026nbsp;(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0\u003cbr\u003e\u0026nbsp;(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1\u003cbr\u003e\u0026nbsp;(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3. Vaccine coverage across different groups [n (%)]\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"983\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003eVaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 62px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n=474)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 280px;\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 333px;\"\u003e\n \u003cp\u003eRegion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 169px;\"\u003e\n \u003cp\u003eSpecimen source\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e18-49\u003c/p\u003e\n \u003cp\u003e(n=72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003cp\u003e(n=91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003cp\u003e(n=142)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026ge;70\u003c/p\u003e\n \u003cp\u003e(n=169)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eEast\u003c/p\u003e\n \u003cp\u003e(n=74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eSouth\u003c/p\u003e\n \u003cp\u003e(n=52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eWest\u003c/p\u003e\n \u003cp\u003e(n=113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eNorth\u003c/p\u003e\n \u003cp\u003e(n=219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eCentral\u003c/p\u003e\n \u003cp\u003e(n=16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eInvasive\u003c/p\u003e\n \u003cp\u003e(n=51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eNon-invasive\u003c/p\u003e\n \u003cp\u003e(n=423)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003ePCV13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e298\u003cbr\u003e\u0026nbsp;(62.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e43\u003cbr\u003e\u0026nbsp;(59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e61\u003cbr\u003e\u0026nbsp;(67.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e85\u003cbr\u003e\u0026nbsp;(59.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e109\u003cbr\u003e\u0026nbsp;(64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e56\u003cbr\u003e\u0026nbsp;(75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e31\u003cbr\u003e\u0026nbsp;(59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e72\u003cbr\u003e\u0026nbsp;(63.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e129\u003cbr\u003e\u0026nbsp;(58.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e10\u003cbr\u003e\u0026nbsp;(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e37\u003cbr\u003e\u0026nbsp;(72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e261\u003cbr\u003e\u0026nbsp;(61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003ePCV15 (MSD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e302\u003cbr\u003e\u0026nbsp;(63.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e43\u003cbr\u003e\u0026nbsp;(59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e61\u003cbr\u003e\u0026nbsp;(67.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e88\u003cbr\u003e\u0026nbsp;(62.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e110\u003cbr\u003e\u0026nbsp;(65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e56\u003cbr\u003e\u0026nbsp;(75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e31\u003cbr\u003e\u0026nbsp;(59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e73\u003cbr\u003e\u0026nbsp;(64.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e132\u003cbr\u003e\u0026nbsp;(60.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e10\u003cbr\u003e\u0026nbsp;(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e39\u003cbr\u003e\u0026nbsp;(76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e263\u003cbr\u003e\u0026nbsp;(62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003ePCV15 (Zhifei)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e299\u003cbr\u003e\u0026nbsp;(63.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e44\u003cbr\u003e\u0026nbsp;(61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e61\u003cbr\u003e\u0026nbsp;(67.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e85\u003cbr\u003e\u0026nbsp;(59.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e109\u003cbr\u003e\u0026nbsp;(64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e56\u003cbr\u003e\u0026nbsp;(75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e32\u003cbr\u003e\u0026nbsp;(61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e72\u003cbr\u003e\u0026nbsp;(63.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e129\u003cbr\u003e\u0026nbsp;(58.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e10\u003cbr\u003e\u0026nbsp;(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e37\u003cbr\u003e\u0026nbsp;(72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e262\u003cbr\u003e\u0026nbsp;(61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003ePCV20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e329\u003cbr\u003e\u0026nbsp;(69.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e51\u003cbr\u003e\u0026nbsp;(70.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e66\u003cbr\u003e\u0026nbsp;(72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e96\u003cbr\u003e\u0026nbsp;(67.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e116\u003cbr\u003e\u0026nbsp;(68.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e61\u003cbr\u003e\u0026nbsp;(82.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e34\u003cbr\u003e\u0026nbsp;(65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e77\u003cbr\u003e\u0026nbsp;(68.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e146\u003cbr\u003e\u0026nbsp;(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e11\u003cbr\u003e\u0026nbsp;(68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e41\u003cbr\u003e\u0026nbsp;(80.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e288\u003cbr\u003e\u0026nbsp;(68.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003ePCV21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e171\u003cbr\u003e\u0026nbsp;(36.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e21\u003cbr\u003e\u0026nbsp;(29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e34\u003cbr\u003e\u0026nbsp;(37.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e60\u003cbr\u003e\u0026nbsp;(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e56\u003cbr\u003e\u0026nbsp;(33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e28\u003cbr\u003e\u0026nbsp;(37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e13\u003cbr\u003e\u0026nbsp;(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e48\u003cbr\u003e\u0026nbsp;(42.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e77\u003cbr\u003e\u0026nbsp;(35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e5\u003cbr\u003e\u0026nbsp;(31.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e20\u003cbr\u003e\u0026nbsp;(39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e151\u003cbr\u003e\u0026nbsp;(35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003ePPV23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e310\u003cbr\u003e\u0026nbsp;(65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e49\u003cbr\u003e\u0026nbsp;(68.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e61\u003cbr\u003e\u0026nbsp;(67.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e82\u003cbr\u003e\u0026nbsp;(57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e118\u003cbr\u003e\u0026nbsp;(69.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e56\u003cbr\u003e\u0026nbsp;(75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e32\u003cbr\u003e\u0026nbsp;(61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e70\u003cbr\u003e\u0026nbsp;(61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e140\u003cbr\u003e\u0026nbsp;(63.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e12\u003cbr\u003e\u0026nbsp;(75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e36\u003cbr\u003e\u0026nbsp;(70.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e274\u003cbr\u003e\u0026nbsp;(64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eNon-vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e88\u003cbr\u003e\u0026nbsp;(18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e17\u003cbr\u003e\u0026nbsp;(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e15\u003cbr\u003e\u0026nbsp;(16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e28\u003cbr\u003e\u0026nbsp;(19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e28\u003cbr\u003e\u0026nbsp;(16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e8\u003cbr\u003e\u0026nbsp;(10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e11\u003cbr\u003e\u0026nbsp;(21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e19\u003cbr\u003e\u0026nbsp;(16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e47\u003cbr\u003e\u0026nbsp;(21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003cbr\u003e\u0026nbsp;(18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e7\u003cbr\u003e\u0026nbsp;(13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e81\u003cbr\u003e\u0026nbsp;(19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 4. Antibiotic resistance of \u003cem\u003eS. pneumoniae\u0026nbsp;\u003c/em\u003eby regions.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eAntibiotic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eCentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eEast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eWest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eSouth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eNorth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eAll Regions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003ePenicillin (Meningitis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.00% (0/1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e100.00% (2/2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e50.00% (1/2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e50.00% (1/2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e57.14% (4/7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003ePenicillin (Non-meningitis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e12.50% (2/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5.56% (4/72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.80% (2/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e4.00% (2/50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.84% (4/217)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3.00% (14/466)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003ePenicillin (Oral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e25.00% (4/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e50.68% (37/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e51.33% (58/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e55.77% (29/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e40.64% (89/219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e45.88% (217/473)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eAmoxicillin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e18.75% (3/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e9.59% (7/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e23.89% (27/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e23.08% (12/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e13.70% (30/219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e16.70% (79/473)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eCefaclor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e31.25% (5/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e69.86% (51/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e73.45% (83/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e63.46% (33/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e59.82% (131/219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e64.06% (303/473)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eCefuroxime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e31.25% (5/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e56.16% (41/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e62.83% (71/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e63.46% (33/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e47.49% (104/219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e53.70% (254/473)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eCefuroxime(Oral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e31.25% (5/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e49.32% (36/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e59.29% (67/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e61.54% (32/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e40.64% (89/219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e48.41% (229/473)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eCeftriaxone (Non-meningitis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e12.50% (2/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e15.28% (11/72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e13.51% (15/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e20.00% (10/50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e16.13% (35/217)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e15.67% (73/466)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eCeftriaxone (Meningitis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.00% (0/1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e50.00% (1/2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.00% (0/2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e50.00% (1/2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e28.57% (2/7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eVancomycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.00% (0/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.00% (0/74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.00% (0/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.00% (0/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.00% (0/219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.00% (0/474)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eErythromycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e93.75% (15/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e97.30% (72/74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e94.69% (107/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e88.00% (44/50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e94.04% (205/218)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e94.06% (443/471)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eAzithromycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e93.75% (15/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e97.26% (71/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e92.04% (104/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e78.85% (41/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e94.52% (207/219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e92.60% (438/473)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eClarithromycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e93.75% (15/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e93.15% (68/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e92.04% (104/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e82.69% (43/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e93.12% (203/218)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e91.74% (433/472)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eTetracycline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e87.50% (14/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e91.78% (67/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e88.50% (100/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e94.23% (49/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e88.58% (194/219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e89.64% (424/473)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eLevofloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.00% (0/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2.70% (2/74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.77% (2/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3.85% (2/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2.74% (6/219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2.53% (12/474)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eMoxifloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.00% (0/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.00% (0/74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.00% (0/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.00% (0/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.91% (2/219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.42% (2/474)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eTrimethoprim-Sulfamethoxazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e68.75% (11/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e65.75% (48/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e65.49% (74/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e51.92% (27/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e52.29% (114/218)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e58.05% (274/472)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eChloramphenicol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e12.50% (2/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e8.11% (6/74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e10.62% (12/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5.77% (3/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e7.76% (17/219)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e8.44% (40/474)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eClindamycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e93.75% (15/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e97.26% (71/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e89.38% (101/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e67.31% (35/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e88.53% (193/218)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e87.92% (415/472)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eMDR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e93.75% (15/16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e97.26% (71/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e92.92% (105/113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e90.00% (45/50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e94.95% (207/218)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e94.06% (443/471)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5. Antibiotic resistance of \u003cem\u003eS. pneumoniae\u0026nbsp;\u003c/em\u003eby disease category.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eAntibiotic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\"\u003e\n \u003cp\u003eInvasive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\"\u003e\n \u003cp\u003eNon-Invasive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber of Resistant strains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal Number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eResistant Rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber of Resistant strains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal Number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eResistant Rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePenicillin (Meningitis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57.14\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePenicillin (Non-meningitis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.27\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.08\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePenicillin (Oral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.41\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47.87\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAmoxicillin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.76\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.30\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCefaclor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.02\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65.88\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCefuroxime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39.22\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55.45\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCefuroxime(Oral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37.25\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.76\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCeftriaxone (Non-meningitis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.64\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.88\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCeftriaxone (Meningitis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.57\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVancomycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eErythromycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94.12\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94.05\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAzithromycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e90.20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e92.89\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eClarithromycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e90.20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.92\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTetracycline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e96.08\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e88.86\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLevofloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.92\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.36\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMoxifloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.47\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTrimethoprim-Sulfamethoxazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.02\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59.14\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChloramphenicol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.76\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.04\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eClindamycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e82.35\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e88.60\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMDR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e92.16\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94.29\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 6. Antibiotic resistance of \u003cem\u003eS. pneumoniae\u0026nbsp;\u003c/em\u003eby vaccine types.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"532\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eAntibiotic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003ePCV13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003ePCV15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003ePCV20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003ePCV21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003ePPV23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003ePenicillin (Meningitis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e50.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e50.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e25.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e66.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e25.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003ePenicillin (Non-meningitis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e4.07%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e4.01%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e3.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2.98%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e3.93%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003ePenicillin (Oral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e56.57%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e55.81%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e54.27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e50.29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e51.78%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eAmoxicillin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e25.25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e24.92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e23.17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e13.45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e23.62%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eCefaclor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e72.39%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e71.43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e70.43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e68.42%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e67.64%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eCefuroxime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e62.96%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e62.13%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e61.59%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e57.31%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e59.22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eCefuroxime(Oral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e57.91%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e57.14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e56.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e52.63%\u003c/p\u003e\n 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style=\"width: 199px;\"\u003e\n \u003cp\u003eErythromycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e94.61%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e94.68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e94.82%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e96.47%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e94.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eAzithromycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e94.28%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e94.35%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e94.51%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e93.57%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e93.85%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eClarithromycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e93.27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e93.36%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e93.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e94.15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e92.88%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eTetracycline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e90.91%\u003c/p\u003e\n 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\u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eMoxifloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.58%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eTrimethoprim-Sulfamethoxazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e63.64%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e63.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e64.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e61.99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e62.78%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eChloramphenicol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e7.38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e7.95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e8.21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e11.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e9.03%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eClindamycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e91.25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e90.37%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e90.24%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e86.55%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e89.32%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eMDR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e95.29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e95.35%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e95.43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e95.29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e94.82%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Streptococcus pneumoniae, Serotype, Antimicrobial resistance, Pneumococcal conjunctive vaccine, adult, China, PCV20","lastPublishedDoi":"10.21203/rs.3.rs-6513636/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6513636/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003e\u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e (\u003cem\u003eS. pneumoniae\u003c/em\u003e) remains a major cause of community acquired pneumonia (CAP), particularly among older adults. In China, pneumococcal infections pose a substantial disease burden, with rising antibiotic resistance. Although vaccines have effectively reduced disease worldwide, data on adult serotype distribution and resistance in China are scarce. This study investigates serotype patterns and antimicrobial susceptibility of \u003cem\u003eS. pneumoniae\u003c/em\u003e among Chinese adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe collected a total of 474\u003cem\u003e S. pneumoniae\u003c/em\u003e isolates from adult patients diagnosed with pneumococcal infections in 14 cities across five geographic regions of China between 2018 and 2019. Clinical specimens included sputum, blood, bronchoalveolar lavage fluid (BALF), cerebrospinal fluid (CSF), pharyngeal and nasal swabs, and middle ear fluid. Minimum inhibitory concentrations (MICs) of antimicrobial agents were determined using the agar dilution method. Pneumococcal serotyping was performed using the Pneumotest-Latex kit and type-specific antisera.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSerotype 19F was the most prevalent across all age groups, specimen types, and regions. 20-valent pneumococcal conjugate vaccine (PCV20) is expected to provide the highest serotype coverage (69.4%) among all vaccines evaluated. Multidrug resistance was detected in over 94% of isolates, with high resistance to macrolides, tetracycline, and clindamycin. β-lactam resistance varied by syndrome and region. Non-invasive isolates showed slightly higher resistance than invasive ones. Serotypes covered by higher-valency vaccines were more likely to be antibiotic-resistant, although fluoroquinolone and vancomycin resistance remained low.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eOur findings highlight a high burden of antimicrobial resistance and predominance of specific serotypes, particularly 19F, among adult \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates in China. The broad serotype coverage of PCV20 suggests its potential advantage in future adult immunization strategies. Continued surveillance of serotype distribution and resistance patterns is essential to inform vaccine policy and guide effective antibiotic use.\u003c/p\u003e","manuscriptTitle":"Distribution of serotypes and antibiotic resistance profiles of Streptococcus pneumoniae in hospitalized adult patients: A retrospective multicenter surveillance in China (2018-2019)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 11:10:55","doi":"10.21203/rs.3.rs-6513636/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-16T13:51:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-12T08:46:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84938925704119106697876640011885053474","date":"2025-05-24T05:03:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T17:59:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"269137131880803938076984612674001203094","date":"2025-05-02T05:59:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"317461297687103730799277239628947786433","date":"2025-05-01T11:56:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-29T11:35:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-25T07:39:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-25T07:35:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-04-23T14:30:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9133a2e6-0f05-45c7-b564-06303357ec2a","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-11T15:59:21+00:00","versionOfRecord":{"articleIdentity":"rs-6513636","link":"https://doi.org/10.1186/s12879-025-11377-5","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2025-08-05 15:56:51","publishedOnDateReadable":"August 5th, 2025"},"versionCreatedAt":"2025-05-07 11:10:55","video":"","vorDoi":"10.1186/s12879-025-11377-5","vorDoiUrl":"https://doi.org/10.1186/s12879-025-11377-5","workflowStages":[]},"version":"v1","identity":"rs-6513636","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6513636","identity":"rs-6513636","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}