title: Multicenter surveillance of Streptococcus pneumoniae isolates from middle ear and mastoid cultures in the 13-valent pneumococcal conjugate vaccine era.
abstract: BACKGROUND
  Streptococcus pneumoniae is a common cause of otitis media (OM) in children; mastoiditis remains an important complication of OM. Limited data are available on the impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal otitis.
  
  
  METHODS
  Investigators from 8 children's hospitals in the United States prospectively collected pneumococcal isolates from middle ear or mastoid cultures from children from 2011 to 2013. Serotype and antibiotic susceptibilities were determined and PCV13 doses for children documented.
  
  
  RESULTS
  Over the 3-year period, the proportion of isolates included in PCV13 (plus a related serotype) decreased significantly (P = .0006) among the middle ear/mastoid isolates (2011, 50% [74/149]; 2012, 40.5% [47/116]; 2013, 29% [34/118]). The number of serotype 19A isolates in 2013 (n = 12, 10.2% of total) decreased 76% compared with the number of 19A isolates in 2011 (n = 50, 33.6% of total). Of the children from whom serotype 19A was isolated (n = 93), 55% had previously received <3 doses of PCV13. The most common non-PCV13 serotypes for the combined years were 35B (n = 37), 21 (n = 20), 23B (n = 20), 15B (n = 18), 11 (n = 17), 23A (n = 14), 15A (n = 14), and 15C (n = 14). The proportion of isolates with a penicillin minimal inhibitory concentration >2 µg/mL decreased significantly over the 3 years (2011, 22% [35/154]; 2012, 20% [24/118]; 2013, 10% [12/120]; P < .02).
  
  
  CONCLUSIONS
  The number of pneumococcal isolates and the percentage of isolates with high-level penicillin resistance from cultures taken from children with OM or mastoiditis for clinical indications have decreased following PCV13 use, largely related to decreases in serotype 19A isolates.
authors: Pediatric Infectious Diseases Sections, Baylor College of Medicine, Houston, Texas.
authors: Sheldon L
authors: SL
authors: Kaplan
authors: Pfizer Vaccine Research, Collegeville, Pennsylvania Pfizer Vaccine Research, Pearl River, New York.
authors: Kimberly J
authors: KJ
authors: Center
authors: The Ohio State University College of Medicine and Public Health, Columbus.
authors: William J
authors: WJ
authors: Barson
authors: Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pennsylvania.
authors: Philana
authors: P
authors: Ling-Lin
authors: University of Arkansas for Medical Sciences, Little Rock.
authors: José R
authors: JR
authors: Romero
authors: Rady Children's Hospital San Diego, California.
authors: John S
authors: JS
authors: Bradley
authors: Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors: Tina Q
authors: TQ
authors: Tan
authors: University of Southern California School of Medicine, Los Angeles.
authors: Jill A
authors: JA
authors: Hoffman
authors: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors: Timothy R
authors: TR
authors: Peters
authors: Pfizer Vaccine Research, Collegeville, Pennsylvania Pfizer Vaccine Research, Pearl River, New York.
authors: Alejandra
authors: A
authors: Gurtman
authors: Pfizer Vaccine Research, Collegeville, Pennsylvania Pfizer Vaccine Research, Pearl River, New York.
authors: Daniel A
authors: DA
authors: Scott
authors: inVentive Health Clinical, Princeton, New Jersey.
authors: James
authors: J
authors: Trammel
authors: Pfizer Vaccine Research, Collegeville, Pennsylvania Pfizer Vaccine Research, Pearl River, New York.
authors: William C
authors: WC
authors: Gruber
authors: Pediatric Infectious Diseases Sections, Baylor College of Medicine, Houston, Texas.
authors: Kristina G
authors: KG
authors: Hulten
authors: Pediatric Infectious Diseases Sections, Baylor College of Medicine, Houston, Texas.
authors: Edward O
authors: EO
authors: Mason
mesh_terms: D002648:Child; D002675:Child, Preschool; D004432:Ear, Middle / Q000382:microbiology*; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008416:Mastoid / Q000382:microbiology*; D008417:Mastoiditis / Q000453:epidemiology / Q000382:microbiology*; D008826:Microbial Sensitivity Tests; D010033:Otitis Media / Q000453:epidemiology / Q000382:microbiology*; D010406:Penicillins / Q000494:pharmacology; D011008:Pneumococcal Infections / Q000453:epidemiology*; D022242:Pneumococcal Vaccines; D011446:Prospective Studies; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: C538862:13-valent pneumococcal vaccine; D010406:Penicillins; D022242:Pneumococcal Vaccines
keywords: Streptococcus pneumonia; conjugate vaccine; surveillance