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. 1990 Apr;3(2):171–196. doi: 10.1128/cmr.3.2.171

Pneumococcal resistance to antibiotics.

K P Klugman 1
PMCID: PMC358150  PMID: 2187594

Abstract

The geographic distribution of pneumococci resistant to one or more of the antibiotics penicillin, erythromycin, trimethoprim-sulfamethoxazole, and tetracycline appears to be expanding, and there exist foci of resistance to chloramphenicol and rifampin. Multiply resistant pneumococci are being encountered more commonly and are more often community acquired. Factors associated with infection caused by resistant pneumococci include young age, duration of hospitalization, infection with a pneumococcus of serogroup 6, 19, or 23 or serotype 14, and exposure to antibiotics to which the strain is resistant. At present, the most useful drugs for the management of resistant pneumococcal infections are cefotaxime, ceftriaxone, vancomycin, and rifampin. If the strains are susceptible, chloramphenicol may be useful as an alternative, less expensive agent. Appropriate interventions for the control of resistant pneumococcal outbreaks include investigation of the prevalence of resistant strains, isolation of patients, possible treatment of carriers, and reduction of usage of antibiotics to which the strain is resistant. The molecular mechanisms of penicillin resistance are related to the structure and function of penicillin-binding proteins, and the mechanisms of resistance to other agents involved in multiple resistance are being elucidated. Recognition is increasing of the standard screening procedure for penicillin resistance, using a 1-microgram oxacillin disk.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. AUSTRIAN R., GOLD J. PNEUMOCOCCAL BACTEREMIA WITH ESPECIAL REFERENCE TO BACTEREMIC PNEUMOCOCCAL PNEUMONIA. Ann Intern Med. 1964 May;60:759–776. doi: 10.7326/0003-4819-60-5-759. [DOI] [PubMed] [Google Scholar]
  2. Acar J. F., Buu-Hoi A. Y. Resistance patterns of important gram-positive pathogens. J Antimicrob Chemother. 1988 Apr;21 (Suppl 100):41–47. doi: 10.1093/jac/21.suppl_c.41. [DOI] [PubMed] [Google Scholar]
  3. Ahronheim G. A., Reich B., Marks M. I. Penicillin-insensitive pneumococci. Case report and review. Am J Dis Child. 1979 Feb;133(2):187–191. doi: 10.1001/archpedi.1979.02130020079017. [DOI] [PubMed] [Google Scholar]
  4. Amitai Y., Rotenberg M., Wirtschafter D., Haas H., Michel J. Increasing frequency of penicillin-resistant pneumococci: epidemiological aspects and case-control study. Isr J Med Sci. 1985 Apr;21(4):340–345. [PubMed] [Google Scholar]
  5. Appelbaum P. C., Bhamjee A., Scragg J. N., Hallett A. F., Bowen A. J., Cooper R. C. Streptococcus pneumoniae resistant to penicillin and chloramphenicol. Lancet. 1977 Nov 12;2(8046):995–997. doi: 10.1016/s0140-6736(77)92892-6. [DOI] [PubMed] [Google Scholar]
  6. Appelbaum P. C., Spangler S. K., Crotty E., Jacobs M. R. Susceptibility of penicillin-sensitive and -resistant strains of Streptococcus pneumoniae to new antimicrobial agents, including daptomycin, teicoplanin, cefpodoxime and quinolones. J Antimicrob Chemother. 1989 Apr;23(4):509–516. doi: 10.1093/jac/23.4.509. [DOI] [PubMed] [Google Scholar]
  7. Appelbaum P. C. World-wide development of antibiotic resistance in pneumococci. Eur J Clin Microbiol. 1987 Aug;6(4):367–377. doi: 10.1007/BF02013089. [DOI] [PubMed] [Google Scholar]
  8. Austrian R., Howie V. M., Ploussard J. H. The bacteriology of pneumococcal otitis media. Johns Hopkins Med J. 1977 Sep;141(3):104–111. [PubMed] [Google Scholar]
  9. Austrian R. Maxwell Finland Lecture. Random gleanings from a life with the pneumococcus. J Infect Dis. 1975 Apr;131(4):474–484. doi: 10.1093/infdis/131.4.474. [DOI] [PubMed] [Google Scholar]
  10. Austrian R. Some aspects of the pneumococcal carrier state. J Antimicrob Chemother. 1986 Jul;18 (Suppl A):35–45. doi: 10.1093/jac/18.supplement_a.35. [DOI] [PubMed] [Google Scholar]
  11. Beam T. R. Vancomycin therapy of experimental pneumococcal meningitis caused by penicillin-sensitive and resistant strains. J Antimicrob Chemother. 1981 Jan;7(1):89–99. doi: 10.1093/jac/7.1.89. [DOI] [PubMed] [Google Scholar]
  12. Berkowitz F. E. Bacteremia in hospitalized black South African children. A one-year study emphasizing nosocomial bacteremia and bacteremia in severely malnourished children. Am J Dis Child. 1984 Jun;138(6):551–556. doi: 10.1001/archpedi.1984.02140440035008. [DOI] [PubMed] [Google Scholar]
  13. Berry A. M., Lock R. A., Hansman D., Paton J. C. Contribution of autolysin to virulence of Streptococcus pneumoniae. Infect Immun. 1989 Aug;57(8):2324–2330. doi: 10.1128/iai.57.8.2324-2330.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Bizzozero O. J., Jr, Andriole V. T. Tetracycline-resistant pneumococcal infection. Incidence, clinical presentation, and laboratory evaluation. Arch Intern Med. 1969 Apr;123(4):388–393. [PubMed] [Google Scholar]
  15. Bolan G., Broome C. V., Facklam R. R., Plikaytis B. D., Fraser D. W., Schlech W. F., 3rd Pneumococcal vaccine efficacy in selected populations in the United States. Ann Intern Med. 1986 Jan;104(1):1–6. doi: 10.7326/0003-4819-104-1-1. [DOI] [PubMed] [Google Scholar]
  16. Bosley G. S., Elliott J. A., Oxtoby M. J., Facklam R. R. Susceptibility of relatively penicillin-resistant Streptococcus pneumoniae to newer cephalosporin antibiotics. Diagn Microbiol Infect Dis. 1987 May;7(1):21–27. doi: 10.1016/0732-8893(87)90065-4. [DOI] [PubMed] [Google Scholar]
  17. Bratton L., Teele D. W., Klein J. O. Outcome of unsuspected pneumococcemia in children not initially admitted to the hospital. J Pediatr. 1977 May;90(5):703–706. doi: 10.1016/s0022-3476(77)81231-6. [DOI] [PubMed] [Google Scholar]
  18. Briese T., Hakenbeck R. Interaction of the pneumococcal amidase with lipoteichoic acid and choline. Eur J Biochem. 1985 Jan 15;146(2):417–427. doi: 10.1111/j.1432-1033.1985.tb08668.x. [DOI] [PubMed] [Google Scholar]
  19. Bullen B., Hansman D. Letter: Bacteraemia caused by tetracycline-resistant Pneumococcus type 1. Lancet. 1975 Feb 22;1(7904):466–467. doi: 10.1016/s0140-6736(75)91547-0. [DOI] [PubMed] [Google Scholar]
  20. Burdett V. Streptococcal tetracycline resistance mediated at the level of protein synthesis. J Bacteriol. 1986 Feb;165(2):564–569. doi: 10.1128/jb.165.2.564-569.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Burke J. P., Klein J. O., Gezon H. M., Finland M. Pneumococcal bacteremia. Review of 111 cases, 1957--1969, with special reference to cases with undetermined focus. Am J Dis Child. 1971 Apr;121(4):353–359. [PubMed] [Google Scholar]
  22. Butler L. O., Nicholas G. Mapping of the pneumococcus chromosome. Linkage between the genes conferring resistances to erythromycin and tetracycline and its implication to the replication of the chromosome. J Gen Microbiol. 1973 Nov;79(1):31–44. doi: 10.1099/00221287-79-1-31. [DOI] [PubMed] [Google Scholar]
  23. Buu-Hoï A. Y., Goldstein F. W., Acar J. F. A seventeen-year epidemiological survey of antimicrobial resistance in pneumococci in two hospitals. J Antimicrob Chemother. 1988 Jul;22 (Suppl B):41–52. doi: 10.1093/jac/22.supplement_b.41. [DOI] [PubMed] [Google Scholar]
  24. Buu-Hoï A., Horodniceanu T. Conjugative transfer of multiple antibiotic resistance markers in Streptococcus pneumoniae. J Bacteriol. 1980 Jul;143(1):313–320. doi: 10.1128/jb.143.1.313-320.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Buzón L. M., Guerrero A., Romero J., Santamaria J. M., Bouza E. Penicillin-resistant Streptococcus pneumoniae meningitis successfully treated with vancomycin. Eur J Clin Microbiol. 1984 Oct;3(5):442–443. doi: 10.1007/BF02017368. [DOI] [PubMed] [Google Scholar]
  26. Caillaud F., Carlier C., Courvalin P. Physical analysis of the conjugative shuttle transposon Tn1545. Plasmid. 1987 Jan;17(1):58–60. doi: 10.1016/0147-619x(87)90009-6. [DOI] [PubMed] [Google Scholar]
  27. Caillaud F., Trieu-Cuot P., Carlier C., Courvalin P. Nucleotide sequence of the kanamycin resistance determinant of the pneumococcal transposon Tn1545: evolutionary relationships and transcriptional analysis of aphA-3 genes. Mol Gen Genet. 1987 May;207(2-3):509–513. doi: 10.1007/BF00331623. [DOI] [PubMed] [Google Scholar]
  28. Calandra G., Lydick E., Carrigan J., Weiss L., Guess H. Factors predisposing to seizures in seriously ill infected patients receiving antibiotics: experience with imipenem/cilastatin. Am J Med. 1988 May;84(5):911–918. doi: 10.1016/0002-9343(88)90071-x. [DOI] [PubMed] [Google Scholar]
  29. Caputo G. M., Sattler F. R., Jacobs M. R., Appelbaum P. C. Penicillin-resistant pneumococcus and meningitis. Ann Intern Med. 1983 Mar;98(3):416–417. doi: 10.7326/0003-4819-98-3-416_2. [DOI] [PubMed] [Google Scholar]
  30. Casal J. Antimicrobial susceptibility of Streptococcus pneumoniae: serotype distribution of penicillin-resistant strains in Spain. Antimicrob Agents Chemother. 1982 Aug;22(2):222–225. doi: 10.1128/aac.22.2.222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Cates K. L., Gerrard J. M., Giebink G. S., Lund M. E., Bleeker E. Z., Lau S., O'Leary M. C., Krivit W., Quie P. G. A penicillin-resistant pneumococcus. J Pediatr. 1978 Oct;93(4):624–626. doi: 10.1016/s0022-3476(78)80901-9. [DOI] [PubMed] [Google Scholar]
  32. Chalkley L. J., Koornhof H. J. Penicillin-binding proteins of Streptococcus pneumoniae. J Antimicrob Chemother. 1988 Dec;22(6):791–800. doi: 10.1093/jac/22.6.791. [DOI] [PubMed] [Google Scholar]
  33. Champion L. A., Wald E. R., Luddy R. E., Schwartz A. D. Streptococcus pneumoniae resistant to erythromycin and clindamycin. J Pediatr. 1978 Mar;92(3):505–506. doi: 10.1016/s0022-3476(78)80461-2. [DOI] [PubMed] [Google Scholar]
  34. Cheong Y. M., Jegathesan M., Henrichsen J., Wong Y. H., Ng A. J., Louis A. Antibiotic susceptibility and serotype distribution of Streptococcus pneumoniae in Malaysian children. J Trop Pediatr. 1988 Aug;34(4):182–185. doi: 10.1093/tropej/34.4.182. [DOI] [PubMed] [Google Scholar]
  35. Citron K. M., May J. R. Rifamycin antibiotics in chronic purulent bronchitis. Lancet. 1969 Nov 8;2(7628):982–983. doi: 10.1016/s0140-6736(69)90539-x. [DOI] [PubMed] [Google Scholar]
  36. Collatz E., Carlier C., Courvalin P. Characterization of high-level aminoglycoside resistance in a strain of Streptococcus pneumoniae. J Gen Microbiol. 1984 Jul;130(7):1665–1671. doi: 10.1099/00221287-130-7-1665. [DOI] [PubMed] [Google Scholar]
  37. Collignon P. J., Bell J., Hufton I. W., Mitchell D. Meningitis caused by a penicillin- and chloramphenicol-resistant Streptococcus pneumoniae. Med J Aust. 1988 Nov 7;149(9):497–498. doi: 10.5694/j.1326-5377.1988.tb120739.x. [DOI] [PubMed] [Google Scholar]
  38. Cooksey R. C., Swenson J. M., Clark N. C., Thornsberry C. DNA hybridization studies of a nucleotide sequence homologous to transposon Tn1545 in the "Minnesota" strain of multiresistant Streptococcus pneumoniae isolated in 1977. Diagn Microbiol Infect Dis. 1989 Jan-Feb;12(1):13–16. doi: 10.1016/0732-8893(89)90038-2. [DOI] [PubMed] [Google Scholar]
  39. Corcoran G. D., Buckley T. F., Connor C., Clancy L., Keane C. T. Penicillin-resistant pneumococcus. Ir J Med Sci. 1988 Jan;157(1):15–16. doi: 10.1007/BF02953679. [DOI] [PubMed] [Google Scholar]
  40. Courvalin P., Carlier C. Transposable multiple antibiotic resistance in Streptococcus pneumoniae. Mol Gen Genet. 1986 Nov;205(2):291–297. doi: 10.1007/BF00430441. [DOI] [PubMed] [Google Scholar]
  41. Cybulska J., Jeljaszewicz J., Lund E., Munksgaard A. Prevalence of types of Diplococcus pneumoniae and their susceptibility to 30 antibiotics. Chemotherapy. 1970;15(5):304–316. doi: 10.1159/000220695. [DOI] [PubMed] [Google Scholar]
  42. D'Amato R. F., Swenson J. M., McKinley G. A., Hochstein L., Wallman A. A., Cleri D. J., Mastellone A. J., Fredericks L., Gonzalez L., Pincus D. H. Quantitative antimicrobial susceptibility test for Streptococcus pneumoniae using inoculum supplemented with whole defibrinated sheep blood. J Clin Microbiol. 1987 Sep;25(9):1753–1756. doi: 10.1128/jcm.25.9.1753-1756.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Davies B. I., Maesen F. P. Quinolones in chest infections. J Antimicrob Chemother. 1986 Sep;18(3):296–299. doi: 10.1093/jac/18.3.296. [DOI] [PubMed] [Google Scholar]
  44. Davis R. L., Rompalo A. M., Tartaglione T. A. Pneumonia caused by a relatively resistant strain of Streptococcus pneumoniae. Clin Pharm. 1986 Jun;5(6):517–521. [PubMed] [Google Scholar]
  45. Decker M. D., Gregory D. W., Boldt J., Hutcheson R. H., Jr, Schaffner W. The detection of penicillin-resistant pneumococci. The compliance of hospital laboratories with recommended methods. Am J Clin Pathol. 1985 Sep;84(3):357–360. doi: 10.1093/ajcp/84.3.357. [DOI] [PubMed] [Google Scholar]
  46. Dideberg O., Charlier P., Wéry J. P., Dehottay P., Dusart J., Erpicum T., Frère J. M., Ghuysen J. M. The crystal structure of the beta-lactamase of Streptomyces albus G at 0.3 nm resolution. Biochem J. 1987 Aug 1;245(3):911–913. doi: 10.1042/bj2450911. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Dixon J. M., Lipinski A. E., Graham M. E. Detection and prevalence of pneumococci with increased resistance to penicillin. Can Med Assoc J. 1977 Nov 19;117(10):1159–1161. [PMC free article] [PubMed] [Google Scholar]
  48. Douglas R. M., Paton J. C., Duncan S. J., Hansman D. J. Antibody response to pneumococcal vaccination in children younger than five years of age. J Infect Dis. 1983 Jul;148(1):131–137. doi: 10.1093/infdis/148.1.131. [DOI] [PubMed] [Google Scholar]
  49. Douglas R. M., Sturt J. Letter: penicillin-resistant pneumococci and pneumonia. Med J Aust. 1975 Jan 18;1(3):82–82. [PubMed] [Google Scholar]
  50. Dowson C. G., Hutchison A., Brannigan J. A., George R. C., Hansman D., Liñares J., Tomasz A., Smith J. M., Spratt B. G. Horizontal transfer of penicillin-binding protein genes in penicillin-resistant clinical isolates of Streptococcus pneumoniae. Proc Natl Acad Sci U S A. 1989 Nov;86(22):8842–8846. doi: 10.1073/pnas.86.22.8842. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Dowson C. G., Hutchison A., Spratt B. G. Extensive re-modelling of the transpeptidase domain of penicillin-binding protein 2B of a penicillin-resistant South African isolate of Streptococcus pneumoniae. Mol Microbiol. 1989 Jan;3(1):95–102. doi: 10.1111/j.1365-2958.1989.tb00108.x. [DOI] [PubMed] [Google Scholar]
  52. Dublanchet A., Durieux R. Isolement d'une souche de Streptococcus pneumoniae multirésistante aux antibiotiques. Nouv Presse Med. 1979 Mar 10;8(11):872–872. [PubMed] [Google Scholar]
  53. Ellerbrok H., Hakenbeck R. Penicillin-degrading activities of peptides from pneumococcal penicillin-binding proteins. Eur J Biochem. 1988 Jan 15;171(1-2):219–224. doi: 10.1111/j.1432-1033.1988.tb13779.x. [DOI] [PubMed] [Google Scholar]
  54. Endtz H. P., Peetermans W. E., Bijlmer H. A. Low frequency of erythromycin-resistant Streptococcus pneumoniae in The Netherlands. Lancet. 1989 May 20;1(8647):1144–1145. doi: 10.1016/s0140-6736(89)92427-6. [DOI] [PubMed] [Google Scholar]
  55. Eykyn S. J. Pneumococcaemia caused by erythromycin-resistant Streptococcus pneumoniae type 14. Lancet. 1988 Nov 5;2(8619):1086–1086. doi: 10.1016/s0140-6736(88)90112-2. [DOI] [PubMed] [Google Scholar]
  56. FRANCIS R. S., MAY J. R., SPICER C. C. INFLUENCE OF DAILY PENICILLIN, TETRACYCLINE, ERYTHROMYCIN, AND SULPHAMETHOXYPYRIDAZINE ON EXACERBATIONS OF BRONCHITIS. A REPORT TO THE RESEARCH COMMITTEE OF THE BRITISH TUBERCULOSIS ASSOCIATION. Br Med J. 1964 Mar 21;1(5385):728–732. doi: 10.1136/bmj.1.5385.728. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Fanning E. A., Gotjamanos T., Vowles N. J. Dental caries in children related to availability of sweets at school canteens. Med J Aust. 1969 May 31;1(22):1131–1132. doi: 10.5694/j.1326-5377.1969.tb62207.x. [DOI] [PubMed] [Google Scholar]
  58. Feldman C., Kallenbach J. M., Miller S. D., Thorburn J. R., Koornhof H. J. Community-acquired pneumonia due to penicillin-resistant pneumococci. N Engl J Med. 1985 Sep 5;313(10):615–617. doi: 10.1056/NEJM198509053131006. [DOI] [PubMed] [Google Scholar]
  59. Figura N., Rossolini A., Tagliaferri L., Saletti M. Prevalence of chemoresistance in recent clinical isolates of "Streptococcus pneumoniae". Ann Sclavo. 1982 Jan-Feb;24(1):93–100. [PubMed] [Google Scholar]
  60. Finland M. And the walls come tumbling down. More antibiotic resistance, and now the pneumococcus. N Engl J Med. 1978 Oct 5;299(14):770–771. doi: 10.1056/NEJM197810052991408. [DOI] [PubMed] [Google Scholar]
  61. Finland M. Increased resistance in the pneumococcus. N Engl J Med. 1971 Jan 28;284(4):212–214. doi: 10.1056/NEJM197101282840411. [DOI] [PubMed] [Google Scholar]
  62. Fishbein D. B., Sawyer L. A., Reid-Sanden F. L., Weir E. H. Administration of human diploid-cell rabies vaccine in the gluteal area. N Engl J Med. 1988 Jan 14;318(2):124–125. doi: 10.1056/NEJM198801143180219. [DOI] [PubMed] [Google Scholar]
  63. Frederiksen B., Henrichsen J. Throat carriage of Streptococcus pneumoniae and Streptococcus pyogenes among infants and children in Zambia. J Trop Pediatr. 1988 Jun;34(3):114–117. doi: 10.1093/tropej/34.3.114. [DOI] [PubMed] [Google Scholar]
  64. Garau J., Linares J., Dominguez C. Chloramphenicol-resistant pneumococci. Lancet. 1981 Jul 18;2(8238):147–148. doi: 10.1016/s0140-6736(81)90324-x. [DOI] [PubMed] [Google Scholar]
  65. Garcia-Bustos J. F., Chait B. T., Tomasz A. Altered peptidoglycan structure in a pneumococcal transformant resistant to penicillin. J Bacteriol. 1988 May;170(5):2143–2147. doi: 10.1128/jb.170.5.2143-2147.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. García P., García J. L., García E., López R. Nucleotide sequence and expression of the pneumococcal autolysin gene from its own promoter in Escherichia coli. Gene. 1986;43(3):265–272. doi: 10.1016/0378-1119(86)90215-5. [DOI] [PubMed] [Google Scholar]
  67. García P., García J. L., García E., López R. Purification and characterization of the autolytic glycosidase of Streptococcus pneumoniae. Biochem Biophys Res Commun. 1989 Jan 16;158(1):251–256. doi: 10.1016/s0006-291x(89)80205-0. [DOI] [PubMed] [Google Scholar]
  68. Gartner J. C., Michaels R. H. Meningitis from a pneumococcus moderately resistant to penicillin. JAMA. 1979 Apr 20;241(16):1707–1709. [PubMed] [Google Scholar]
  69. George R. H., Mulligan E. A., Roycroft C. A., Powell A. M. Multiresistant pneumococci. Lancet. 1981 Oct 3;2(8249):751–752. doi: 10.1016/s0140-6736(81)91078-3. [DOI] [PubMed] [Google Scholar]
  70. Gombert M. E., Aulicino T. M. Susceptibility of multiply antibiotic-resistant pneumococci to the new quinoline antibiotics, nalidixic acid, coumermycin, and novobiocin. Antimicrob Agents Chemother. 1984 Dec;26(6):933–934. doi: 10.1128/aac.26.6.933. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Gould F. K., Magee J. G., Ingham H. R. A hospital outbreak of antibiotic-resistant Streptococcus pneumoniae. J Infect. 1987 Jul;15(1):77–79. doi: 10.1016/s0163-4453(87)91576-3. [DOI] [PubMed] [Google Scholar]
  72. Gratten M., Naraqi S., Hansman D. High prevalence of penicillin-insensitive pneumococci in Port Moresby, Papua New Guinea. Lancet. 1980 Jul 26;2(8187):192–195. doi: 10.1016/s0140-6736(80)90072-0. [DOI] [PubMed] [Google Scholar]
  73. Gray B. M., Converse G. M., 3rd, Dillon H. C., Jr Epidemiologic studies of Streptococcus pneumoniae in infants: acquisition, carriage, and infection during the first 24 months of life. J Infect Dis. 1980 Dec;142(6):923–933. doi: 10.1093/infdis/142.6.923. [DOI] [PubMed] [Google Scholar]
  74. Gray B. M., Converse G. M., 3rd, Dillon H. C., Jr Serotypes of Streptococcus pneumoniae causing disease. J Infect Dis. 1979 Dec;140(6):979–983. doi: 10.1093/infdis/140.6.979. [DOI] [PubMed] [Google Scholar]
  75. Gray B. M., Dillon H. C., Jr Clinical and epidemiologic studies of pneumococcal infection in children. Pediatr Infect Dis. 1986 Mar-Apr;5(2):201–207. doi: 10.1097/00006454-198603000-00009. [DOI] [PubMed] [Google Scholar]
  76. Gray B. M., Turner M. E., Dillon H. C., Jr Epidemiologic studies of Streptococcus pneumoniae in infants. The effects of season and age on pneumococcal acquisition and carriage in the first 24 months of life. Am J Epidemiol. 1982 Oct;116(4):692–703. doi: 10.1093/oxfordjournals.aje.a113452. [DOI] [PubMed] [Google Scholar]
  77. Gudiol F. Infecciones producidas por neumococos resistentes a la penicilina. Rev Clin Esp. 1989 Feb;184(3):147–150. [PubMed] [Google Scholar]
  78. Guiscafré H., García-Melgar M., Jaime M., Trejo y Pérez J. A., García M., Hernández-Velarde R., Muñoz O. Screening for ampicillin resistant Hemophilus influenzae and penicillin resistant Streptococcus Pneumoniae in healthy carriers. Arch Invest Med (Mex) 1981;12(1):141–151. [PubMed] [Google Scholar]
  79. HOTCHKISS R. D., EVANS A. H. Analysis of the complex sulfonamide resistance locus of pneumococcus. Cold Spring Harb Symp Quant Biol. 1958;23:85–97. doi: 10.1101/sqb.1958.023.01.012. [DOI] [PubMed] [Google Scholar]
  80. Hakenbeck R., Kohiyama M. Purification of penicillin-binding protein 3 from Streptococcus pneumoniae. Eur J Biochem. 1982 Oct;127(2):231–236. doi: 10.1111/j.1432-1033.1982.tb06860.x. [DOI] [PubMed] [Google Scholar]
  81. Hakenbeck R., Tornette S., Adkinson N. F. Interaction of non-lytic beta-lactams with penicillin-binding proteins in Streptococcus pneumoniae. J Gen Microbiol. 1987 Mar;133(3):755–760. doi: 10.1099/00221287-133-3-755. [DOI] [PubMed] [Google Scholar]
  82. Handwerger S., Tomasz A. Alterations in kinetic properties of penicillin-binding proteins of penicillin-resistant Streptococcus pneumoniae. Antimicrob Agents Chemother. 1986 Jul;30(1):57–63. doi: 10.1128/aac.30.1.57. [DOI] [PMC free article] [PubMed] [Google Scholar]
  83. Handwerger S., Tomasz A. Alterations in penicillin-binding proteins of clinical and laboratory isolates of pathogenic Streptococcus pneumoniae with low levels of penicillin resistance. J Infect Dis. 1986 Jan;153(1):83–89. doi: 10.1093/infdis/153.1.83. [DOI] [PubMed] [Google Scholar]
  84. Hansman D., Andrews G. Hospital infection with pneumococci resistant to tetracycline. Med J Aust. 1967 Mar 11;1(10):498–501. [PubMed] [Google Scholar]
  85. Hansman D. Chloramphenicol-resistant pneumococci in West Africa. Lancet. 1978 May 20;1(8073):1102–1103. doi: 10.1016/s0140-6736(78)90950-9. [DOI] [PubMed] [Google Scholar]
  86. Hansman D., Devitt L., Miles H., Riley I. Pneumococci relatively insensitive to penicillin in Australia and New Guinea. Med J Aust. 1974 Sep 7;2(10):353–356. doi: 10.5694/j.1326-5377.1974.tb70836.x. [DOI] [PubMed] [Google Scholar]
  87. Hansman D., Glasgow H., Sturt J., Devitt L., Douglas R. Increased resistance to penicillin of pneumococci isolated from man. N Engl J Med. 1971 Jan 28;284(4):175–177. doi: 10.1056/NEJM197101282840403. [DOI] [PubMed] [Google Scholar]
  88. Hansman D., Morris S., Gregory M., McDonald B. Pneumococcal carriage amongst Australian aborigines in Alice Springs, Northern Territory. J Hyg (Lond) 1985 Dec;95(3):677–684. doi: 10.1017/s0022172400060782. [DOI] [PMC free article] [PubMed] [Google Scholar]
  89. Hansman D., Morris S. Pneumococcal carriage amongst children in Adelaide, South Australia. Epidemiol Infect. 1988 Oct;101(2):411–417. doi: 10.1017/s0950268800054364. [DOI] [PMC free article] [PubMed] [Google Scholar]
  90. Hansman D. Type distribution and antibiotic sensitivity of pneumococci from carriers in Kiriwina, Trobriand islands (New Guinea). Med J Aust. 1972 Sep 30;2(14):771–773. doi: 10.5694/j.1326-5377.1972.tb103534.x. [DOI] [PubMed] [Google Scholar]
  91. Heffernan H. Antimicrobial susceptibility of clinically-significant Streptococcus pneumoniae isolates. N Z Med J. 1987 May 27;100(824):327–327. [PubMed] [Google Scholar]
  92. Henderson F. W., Gilligan P. H., Wait K., Goff D. A. Nasopharyngeal carriage of antibiotic-resistant pneumococci by children in group day care. J Infect Dis. 1988 Feb;157(2):256–263. doi: 10.1093/infdis/157.2.256. [DOI] [PubMed] [Google Scholar]
  93. Herzberg O., Moult J. Bacterial resistance to beta-lactam antibiotics: crystal structure of beta-lactamase from Staphylococcus aureus PC1 at 2.5 A resolution. Science. 1987 May 8;236(4802):694–701. doi: 10.1126/science.3107125. [DOI] [PubMed] [Google Scholar]
  94. Horinouchi S., Byeon W. H., Weisblum B. A complex attenuator regulates inducible resistance to macrolides, lincosamides, and streptogramin type B antibiotics in Streptococcus sanguis. J Bacteriol. 1983 Jun;154(3):1252–1262. doi: 10.1128/jb.154.3.1252-1262.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  95. Howard A. J., Hince C. J., Williams J. D. Antibiotic resistance in Streptococcus pneumoniae and Haemophilus influenzae. Report of a study group on bacterial resistance. Br Med J. 1978 Jun 24;1(6128):1657–1660. doi: 10.1136/bmj.1.6128.1657. [DOI] [PMC free article] [PubMed] [Google Scholar]
  96. Howe J. G., Wilson T. S. Co-trimoxazole-resistant pneumococci. Lancet. 1972 Jul 22;2(7769):184–185. doi: 10.1016/s0140-6736(72)91354-2. [DOI] [PubMed] [Google Scholar]
  97. Howes V. J., Mitchell R. G. Meningitis due to relatively penicillin-resistant pneumococcus. Br Med J. 1976 Apr 24;1(6016):996–996. doi: 10.1136/bmj.1.6016.996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  98. Höltje J. V., Tomasz A. Lipoteichoic acid: a specific inhibitor of autolysin activity in Pneumococcus. Proc Natl Acad Sci U S A. 1975 May;72(5):1690–1694. doi: 10.1073/pnas.72.5.1690. [DOI] [PMC free article] [PubMed] [Google Scholar]
  99. Istre G. R., Tarpay M., Anderson M., Pryor A., Welch D. Invasive disease due to Streptococcus pneumoniae in an area with a high rate of relative penicillin resistance. J Infect Dis. 1987 Nov;156(5):732–735. doi: 10.1093/infdis/156.5.732. [DOI] [PubMed] [Google Scholar]
  100. Jabes D., Nachman S., Tomasz A. Penicillin-binding protein families: evidence for the clonal nature of penicillin resistance in clinical isolates of pneumococci. J Infect Dis. 1989 Jan;159(1):16–25. doi: 10.1093/infdis/159.1.16. [DOI] [PubMed] [Google Scholar]
  101. Jackson M. A., Shelton S., Nelson J. D., McCracken G. H., Jr Relatively penicillin-resistant pneumococcal infections in pediatric patients. Pediatr Infect Dis. 1984 Mar-Apr;3(2):129–132. doi: 10.1097/00006454-198403000-00010. [DOI] [PubMed] [Google Scholar]
  102. Jacobs M. R., Gaspar M. N., Robins-Browne R. M., Koornhof H. J. Antimicrobial susceptibility testing of pneumococci. 2. Determination of optimal disc diffusion test for detection of penicillin G resistance. J Antimicrob Chemother. 1980 Jan;6(1):53–64. doi: 10.1093/jac/6.1.53. [DOI] [PubMed] [Google Scholar]
  103. Jacobs M. R., Koornhof H. J. Multiple-antibiotic resistance--now the pneumococcus. J Antimicrob Chemother. 1978 Nov;4(6):481–483. doi: 10.1093/jac/4.6.481. [DOI] [PubMed] [Google Scholar]
  104. Jacobs M. R., Koornhof H. J., Robins-Browne R. M., Stevenson C. M., Vermaak Z. A., Freiman I., Miller G. B., Witcomb M. A., Isaäcson M., Ward J. I. Emergence of multiply resistant pneumococci. N Engl J Med. 1978 Oct 5;299(14):735–740. doi: 10.1056/NEJM197810052991402. [DOI] [PubMed] [Google Scholar]
  105. Jacobs M. R., Mithal Y., Robins-Browne R. M., Gaspar M. N., Koornhof H. J. Antimicrobial susceptibility testing of pneumococci: determination of Kirby-Bauer breakpoints for penicillin G, erythromycin, clindamycin, tetracycline, chloramphenicol, and rifampin. Antimicrob Agents Chemother. 1979 Aug;16(2):190–197. doi: 10.1128/aac.16.2.190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  106. Jacobs N. M., Lerdkachornsuk S., Metzger W. I. Pneumococcal bacteremia in infants and children: a ten-year experience at the Cook County Hospital with special reference to the pneumococcal serotypes isolated. Pediatrics. 1979 Sep;64(3):296–300. [PubMed] [Google Scholar]
  107. Jones R. N., Edson D. C. Special topics in antimicrobial susceptibility testing: test accuracy against methicillin-resistant Staphylococcus aureus, pneumococci, and the sensitivity of beta-lactamase methods. Am J Clin Pathol. 1983 Oct;80(4 Suppl):609–614. [PubMed] [Google Scholar]
  108. Jones R. N., Edson D. C. The ability of participant laboratories to detect penicillin-resistant Pneumococci. A report from the microbiology portion of the College of American Pathologists (CAP) surveys. Am J Clin Pathol. 1982 Oct;78(4 Suppl):659–663. [PubMed] [Google Scholar]
  109. Joris B., Ghuysen J. M., Dive G., Renard A., Dideberg O., Charlier P., Frère J. M., Kelly J. A., Boyington J. C., Moews P. C. The active-site-serine penicillin-recognizing enzymes as members of the Streptomyces R61 DD-peptidase family. Biochem J. 1988 Mar 1;250(2):313–324. doi: 10.1042/bj2500313. [DOI] [PMC free article] [PubMed] [Google Scholar]
  110. Juliet C., Giglio M. S., Camponovo R. Sensibilidad de Streptococcus pneumoniae y su importancia clínica. Rev Med Chil. 1987 Sep;115(9):852–857. [PubMed] [Google Scholar]
  111. Kahlmeter G., Kamme C. Tetracycline-resistant group A streptococci and pneumococci. Scand J Infect Dis. 1972;4(3):193–196. doi: 10.3109/inf.1972.4.issue-3.04. [DOI] [PubMed] [Google Scholar]
  112. Kalin M., Carlsson B., Karlsson I. Frequency and type distribution of pneumococcal strains in the Stockholm region with resistance or reduced susceptibility to antibiotics. Scand J Infect Dis. 1984;16(1):73–78. doi: 10.3109/00365548409068411. [DOI] [PubMed] [Google Scholar]
  113. Kaufhold A., Lütticken R., Henrichsen J. Capsular types and antibiotic susceptibility of Streptococcus pneumoniae isolated from patients with systemic infections in West Germany. Eur J Clin Microbiol. 1987 Dec;6(6):696–697. doi: 10.1007/BF02013080. [DOI] [PubMed] [Google Scholar]
  114. Kislak J. W., Razavi L. M., Daly A. K., Finland M. Susceptibility of pneumococci to nine antibiotics. Am J Med Sci. 1965 Sep;250(3):261–268. doi: 10.1097/00000441-196509000-00003. [DOI] [PubMed] [Google Scholar]
  115. Kislak J. W. Type 6 pneumococcus resistant to erythromycin and lincomycin. N Engl J Med. 1967 Apr 13;276(15):852–852. doi: 10.1056/NEJM196704132761508. [DOI] [PubMed] [Google Scholar]
  116. Klugman K. P., Koornhof H. J. Drug resistance patterns and serogroups or serotypes of pneumococcal isolates from cerebrospinal fluid or blood, 1979-1986. J Infect Dis. 1988 Nov;158(5):956–964. doi: 10.1093/infdis/158.5.956. [DOI] [PubMed] [Google Scholar]
  117. Klugman K. P., Koornhof H. J., Kuhnle V. Clinical and nasopharyngeal isolates of unusual multiply resistant pneumococci. Am J Dis Child. 1986 Nov;140(11):1186–1190. doi: 10.1001/archpedi.1986.02140250112045. [DOI] [PubMed] [Google Scholar]
  118. Klugman K. P., Koornhof H. J., Kuhnle V., Miller S. D., Ginsburg P. J., Mauff A. C. Meningitis and pneumonia due to novel multiply resistant pneumococci. Br Med J (Clin Res Ed) 1986 Mar 15;292(6522):730–730. doi: 10.1136/bmj.292.6522.730. [DOI] [PMC free article] [PubMed] [Google Scholar]
  119. Klugman K. P., Koornhof H. J., Wasas A., Storey K., Gilbertson I. Carriage of penicillin resistant pneumococci. Arch Dis Child. 1986 Apr;61(4):377–381. doi: 10.1136/adc.61.4.377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  120. Klugman K. P., Koornhof H. J. Worldwide increase in pneumococcal antibiotic resistance. Lancet. 1989 Aug 19;2(8660):444–444. doi: 10.1016/s0140-6736(89)90617-x. [DOI] [PubMed] [Google Scholar]
  121. Klugman K. P., Koornhof H. Bacteremic pneumonia caused by penicillin-resistant pneumococci. N Engl J Med. 1988 Jan 14;318(2):123–124. doi: 10.1056/NEJM198801143180218. [DOI] [PubMed] [Google Scholar]
  122. Knapp J. S., Johnson S. R., Zenilman J. M., Roberts M. C., Morse S. A. High-level tetracycline resistance resulting from TetM in strains of Neisseria spp., Kingella denitrificans, and Eikenella corrodens. Antimicrob Agents Chemother. 1988 May;32(5):765–767. doi: 10.1128/aac.32.5.765. [DOI] [PMC free article] [PubMed] [Google Scholar]
  123. Knowles M. A., Turner G. C. Penicillin-insensitive pneumococci. Lancet. 1980 Aug 30;2(8192):478–478. doi: 10.1016/s0140-6736(80)91912-1. [DOI] [PubMed] [Google Scholar]
  124. Kontiainen S., Sivonen A. Optochin resistance in Streptococcus pneumoniae strains isolated from blood and middle ear fluid. Eur J Clin Microbiol. 1987 Aug;6(4):422–424. doi: 10.1007/BF02013101. [DOI] [PubMed] [Google Scholar]
  125. Koskela M., Leinonen M., Häivä V. M., Timonen M., Mäkelä P. H. First and second dose antibody responses to pneumococcal polysaccharide vaccine in infants. Pediatr Infect Dis. 1986 Jan-Feb;5(1):45–50. doi: 10.1097/00006454-198601000-00009. [DOI] [PubMed] [Google Scholar]
  126. Lafong A. C., Crothers E., Bamford K. B., Rooney P. J. Distribution of serotypes and antibiotic resistance among pneumococci in Northern Ireland. J Infect. 1988 May;16(3):235–242. doi: 10.1016/s0163-4453(88)97556-1. [DOI] [PubMed] [Google Scholar]
  127. Lai C. J., Weisblum B. Altered methylation of ribosomal RNA in an erythromycin-resistant strain of Staphylococcus aureus. Proc Natl Acad Sci U S A. 1971 Apr;68(4):856–860. doi: 10.1073/pnas.68.4.856. [DOI] [PMC free article] [PubMed] [Google Scholar]
  128. Laible G., Hakenbeck R. Penicillin-binding proteins in beta-lactam-resistant laboratory mutants of Streptococcus pneumoniae. Mol Microbiol. 1987 Nov;1(3):355–363. doi: 10.1111/j.1365-2958.1987.tb01942.x. [DOI] [PubMed] [Google Scholar]
  129. Lampson B. C., Parisi J. T. Naturally occurring Staphylococcus epidermidis plasmid expressing constitutive macrolide-lincosamide-streptogramin B resistance contains a deleted attenuator. J Bacteriol. 1986 May;166(2):479–483. doi: 10.1128/jb.166.2.479-483.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  130. Landesman S. H., Cummings M., Gruarin A., Bernheimer H. Susceptibility of multiply antibiotic-resistant pneumococci to the new beta-lactam drugs and rosaramicin. Antimicrob Agents Chemother. 1981 Apr;19(4):675–677. doi: 10.1128/aac.19.4.675. [DOI] [PMC free article] [PubMed] [Google Scholar]
  131. Lapointe J. R., Joncas J. H. Meningitis in a Canadian infant due to pneumococcus resistant to penicillin and chloramphenicol. J Pediatr. 1983 Oct;103(4):580–582. doi: 10.1016/s0022-3476(83)80590-3. [DOI] [PubMed] [Google Scholar]
  132. Latorre Otín C., Jumcasa Morros T., Sanfeliu Sala I. Antibiotic susceptibility of Streptococcus pneumoniae isolates from paediatric patients. J Antimicrob Chemother. 1988 Nov;22(5):659–665. doi: 10.1093/jac/22.5.659. [DOI] [PubMed] [Google Scholar]
  133. Latorre C., Juncosa T., Sanfeliu I. Antibiotic resistance and serotypes of 100 Streptococcus pneumoniae strains isolated in a children's hospital in Barcelona, Spain. Antimicrob Agents Chemother. 1985 Aug;28(2):357–359. doi: 10.1128/aac.28.2.357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  134. Lawrenson J. B., Klugman K. P., Eidelman J. I., Wasas A., Miller S. D., Lipman J. Fatal infection caused by a multiply resistant type 3 pneumococcus. J Clin Microbiol. 1988 Aug;26(8):1590–1591. doi: 10.1128/jcm.26.8.1590-1591.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  135. Leinonen M., Säkkinen A., Kalliokoski R., Luotonen J., Timonen M., Mäkelä P. H. Antibody response to 14-valent pneumococcal capsular polysaccharide vaccine in pre-school age children. Pediatr Infect Dis. 1986 Jan-Feb;5(1):39–44. doi: 10.1097/00006454-198601000-00008. [DOI] [PubMed] [Google Scholar]
  136. Lin K. T., Lee C. J. Immune response of neonates to pneumococcal polysaccharide-protein conjugate. Immunology. 1982 Jun;46(2):333–342. [PMC free article] [PubMed] [Google Scholar]
  137. Linares J., Pérez J. L., Garau J., Martin R. Cotrimoxazole resistance in pneumococci. Eur J Clin Microbiol. 1983 Oct;2(5):473–474. doi: 10.1007/BF02013907. [DOI] [PubMed] [Google Scholar]
  138. Ling J., Chau P. Y., Leung Y. K., Ng W. S., So S. Y. Antibiotic susceptibility of pneumococci and Haemophilus influenzae isolated from patients with acute exacerbations of chronic bronchitis: prevalence of tetracycline-resistant strains in Hong Kong. J Infect. 1983 Jan;6(1):33–37. doi: 10.1016/s0163-4453(83)95496-8. [DOI] [PubMed] [Google Scholar]
  139. Liu H. H., Tomasz A. A mutant of Streptococcus pneumoniae that exhibits thermosensitive penicillin tolerance and the paradoxical effect. J Gen Microbiol. 1987 Jun;133(6):1611–1618. doi: 10.1099/00221287-133-6-1611. [DOI] [PubMed] [Google Scholar]
  140. Liu H. H., Tomasz A. Penicillin tolerance in multiply drug-resistant natural isolates of Streptococcus pneumoniae. J Infect Dis. 1985 Aug;152(2):365–372. doi: 10.1093/infdis/152.2.365. [DOI] [PubMed] [Google Scholar]
  141. Liñares J., Garau J., Domínguez C., Pérez J. L. Antibiotic resistance and serotypes of Streptococcus pneumoniae from patients with community-acquired pneumococcal disease. Antimicrob Agents Chemother. 1983 Apr;23(4):545–547. doi: 10.1128/aac.23.4.545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  142. Lopez P., Espinosa M., Greenberg B., Lacks S. A. Sulfonamide resistance in Streptococcus pneumoniae: DNA sequence of the gene encoding dihydropteroate synthase and characterization of the enzyme. J Bacteriol. 1987 Sep;169(9):4320–4326. doi: 10.1128/jb.169.9.4320-4326.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  143. Lund E. Types of pneumococci found in blood, spinal fluid and pleural exudate during a period of 15 years (1954-1969). Acta Pathol Microbiol Scand B Microbiol Immunol. 1970;78(3):333–336. doi: 10.1111/j.1699-0463.1970.tb04311.x. [DOI] [PubMed] [Google Scholar]
  144. Mace J. W., Janik D. S., Sauer R. L., Quilligan J. J., Jr Penicillin-resistant pneumococcal meningitis in an immunocompromised infant. J Pediatr. 1977 Sep;91(3):506–507. doi: 10.1016/s0022-3476(77)81339-5. [DOI] [PubMed] [Google Scholar]
  145. Macfarlane J. T. Treatment of lower respiratory infections. Lancet. 1987 Dec 19;2(8573):1446–1449. doi: 10.1016/s0140-6736(87)91140-8. [DOI] [PubMed] [Google Scholar]
  146. Maesen F. P., Davies B. I., Teengs J. P. Pefloxacin in acute exacerbations of chronic bronchitis. J Antimicrob Chemother. 1985 Sep;16(3):379–388. doi: 10.1093/jac/16.3.379. [DOI] [PubMed] [Google Scholar]
  147. Markiewicz Z., Tomasz A. Variation in penicillin-binding protein patterns of penicillin-resistant clinical isolates of pneumococci. J Clin Microbiol. 1989 Mar;27(3):405–410. doi: 10.1128/jcm.27.3.405-410.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  148. Markman M., Mannisi J., Dick J. D., Filburn B., Santos G. W., Saral R. Sulfamethoxazole-trimethoprim-resistant pneumococcal sepsis. JAMA. 1982 Dec 10;248(22):3011–3012. [PubMed] [Google Scholar]
  149. Martin B., Alloing G., Méjean V., Claverys J. P. Constitutive expression of erythromycin resistance mediated by the ermAM determinant of plasmid pAM beta 1 results from deletion of 5' leader peptide sequences. Plasmid. 1987 Nov;18(3):250–253. doi: 10.1016/0147-619x(87)90068-0. [DOI] [PubMed] [Google Scholar]
  150. Martin P., Trieu-Cuot P., Courvalin P. Nucleotide sequence of the tetM tetracycline resistance determinant of the streptococcal conjugative shuttle transposon Tn1545. Nucleic Acids Res. 1986 Sep 11;14(17):7047–7058. doi: 10.1093/nar/14.17.7047. [DOI] [PMC free article] [PubMed] [Google Scholar]
  151. McCracken G. H., Jr, Nelson J. D., Kaplan S. L., Overturf G. D., Rodriguez W. J., Steele R. W. Consensus report: antimicrobial therapy for bacterial meningitis in infants and children. Pediatr Infect Dis J. 1987 Jun;6(6):501–505. [PubMed] [Google Scholar]
  152. McCracken G. H., Jr, Sakata Y. Antimicrobial therapy of experimental meningitis caused by Streptococcus pneumoniae strains with different susceptibilities to penicillin. Antimicrob Agents Chemother. 1985 Feb;27(2):141–145. doi: 10.1128/aac.27.2.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  153. Medoff G. Pneumonia caused by a pneumococcus resistant to erythromycin and lincomycin. Case report. Mo Med. 1974 Aug;71(8):496–497. [PubMed] [Google Scholar]
  154. Meers P. D., Matthews R. B. Multiply resistant pneumococcus. Lancet. 1978 Jul 22;2(8082):219–219. doi: 10.1016/s0140-6736(78)91966-9. [DOI] [PubMed] [Google Scholar]
  155. Michel J., Dickman D., Greenberg Z., Bergner-Rabinowitz S. Serotype distribution of penicillin-resistant pneumococci and their susceptibilities to seven antimicrobial agents. Antimicrob Agents Chemother. 1983 Mar;23(3):397–401. doi: 10.1128/aac.23.3.397. [DOI] [PMC free article] [PubMed] [Google Scholar]
  156. Miyamura S., Ochiai H., Nitahara Y., Nakagawa Y., Terao M. Resistance mechanism of chloramphenicol in Streptococcus haemolyticus, Streptococcus pneumoniae and Streptococcus faecalis. Microbiol Immunol. 1977;21(2):69–76. doi: 10.1111/j.1348-0421.1977.tb02809.x. [DOI] [PubMed] [Google Scholar]
  157. Modai J., Vittecoq D., Decazes J. M., Meulemans A. Penetration of imipenem and cilastatin into cerebrospinal fluid of patients with bacterial meningitis. J Antimicrob Chemother. 1985 Dec;16(6):751–755. doi: 10.1093/jac/16.6.751. [DOI] [PubMed] [Google Scholar]
  158. Monod M., Denoya C., Dubnau D. Sequence and properties of pIM13, a macrolide-lincosamide-streptogramin B resistance plasmid from Bacillus subtilis. J Bacteriol. 1986 Jul;167(1):138–147. doi: 10.1128/jb.167.1.138-147.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  159. Moore E. P., Williams E. W. Hospital transmission of multiply antibiotic-resistant Streptococcus pneumoniae. J Infect. 1988 Mar;16(2):199–200. doi: 10.1016/s0163-4453(88)94147-3. [DOI] [PubMed] [Google Scholar]
  160. Moreillon P., Markiewicz Z., Nachman S., Tomasz A. Two bactericidal targets for penicillin in pneumococci: autolysis-dependent and autolysis-independent killing mechanisms. Antimicrob Agents Chemother. 1990 Jan;34(1):33–39. doi: 10.1128/aac.34.1.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  161. Moreillon P., Tomasz A. Penicillin resistance and defective lysis in clinical isolates of pneumococci: evidence for two kinds of antibiotic pressure operating in the clinical environment. J Infect Dis. 1988 Jun;157(6):1150–1157. doi: 10.1093/infdis/157.6.1150. [DOI] [PubMed] [Google Scholar]
  162. Morse S. A., Johnson S. R., Biddle J. W., Roberts M. C. High-level tetracycline resistance in Neisseria gonorrhoeae is result of acquisition of streptococcal tetM determinant. Antimicrob Agents Chemother. 1986 Nov;30(5):664–670. doi: 10.1128/aac.30.5.664. [DOI] [PMC free article] [PubMed] [Google Scholar]
  163. Mufson M. A., Kruss D. M., Wasil R. E., Metzger W. I. Capsular types and outcome of bacteremic pneumococcal disease in the antibiotic era. Arch Intern Med. 1974 Sep;134(3):505–510. [PubMed] [Google Scholar]
  164. Murphy E. Nucleotide sequence of ermA, a macrolide-lincosamide-streptogramin B determinant in Staphylococcus aureus. J Bacteriol. 1985 May;162(2):633–640. doi: 10.1128/jb.162.2.633-640.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  165. Nair P. Incidence of decreased penicillin sensitivity of Streptococcus pneumoniae from clinical isolates. J Clin Pathol. 1988 Jul;41(7):720–721. doi: 10.1136/jcp.41.7.720. [DOI] [PMC free article] [PubMed] [Google Scholar]
  166. Naraqi S., Kirkpatrick G. P., Kabins S. Relapsing pneumococcal meningitis: isolation of an organism with decreased susceptibility to penicillin G. J Pediatr. 1974 Nov;85(5):671–673. doi: 10.1016/s0022-3476(74)80513-5. [DOI] [PubMed] [Google Scholar]
  167. O'Donnell E. D., Alter K. E., Frenkel L. D. Postoperative infection caused by an unusual serotype of Streptococcus pneumoniae associated with multiple drug resistance. J Clin Microbiol. 1982 May;15(5):967–968. doi: 10.1128/jcm.15.5.967-968.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
  168. Oppenheim B., Koornhof H. J., Austrian R. Antibiotic-resistant pneumococcal disease in children at Baragwanath Hospital, Johannesburg. Pediatr Infect Dis. 1986 Sep-Oct;5(5):520–524. doi: 10.1097/00006454-198609000-00006. [DOI] [PubMed] [Google Scholar]
  169. Oxley D. K. Penicillin-resistant pneumococci. Arch Pathol Lab Med. 1984 Feb;108(2):106–107. [PubMed] [Google Scholar]
  170. Pabst H. F., Nigrin J. Penicillin resistance of pneumococci and immune deficiency. Lancet. 1979 Aug 18;2(8138):359–360. doi: 10.1016/s0140-6736(79)90369-6. [DOI] [PubMed] [Google Scholar]
  171. Pallares R., Gudiol F., Liñares J., Ariza J., Rufi G., Murgui L., Dorca J., Viladrich P. F. Risk factors and response to antibiotic therapy in adults with bacteremic pneumonia caused by penicillin-resistant pneumococci. N Engl J Med. 1987 Jul 2;317(1):18–22. doi: 10.1056/NEJM198707023170104. [DOI] [PubMed] [Google Scholar]
  172. Paredes A., Taber L. H., Yow M. D., Clark D., Nathan W. Prolonged pneumococcal meningitis due to an organism with increased resistance to penicillin. Pediatrics. 1976 Sep;58(3):378–381. [PubMed] [Google Scholar]
  173. Parker R. H., Davison R., Paterson P. Y., Madden G. M. Erythromycin-resistant pneumococcal osteomyelitis. Am J Med. 1970 Jan;48(1):132–136. doi: 10.1016/0002-9343(70)90108-7. [DOI] [PubMed] [Google Scholar]
  174. Paton J. H., Reeves D. S. First multiresistant pneumococcus in Britain. Br Med J (Clin Res Ed) 1987 Oct 3;295(6602):810–811. doi: 10.1136/bmj.295.6602.810. [DOI] [PMC free article] [PubMed] [Google Scholar]
  175. Penicillin-resistant strains of Neisseria meningitidis in Spain. Lancet. 1988 Jun 25;1(8600):1452–1453. [PubMed] [Google Scholar]
  176. Percival A. Increased incidence of tetracycline-resistant pneumococci in Liverpool in 1968. Lancet. 1969 May 17;1(7603):998–1000. doi: 10.1016/s0140-6736(69)91799-1. [DOI] [PubMed] [Google Scholar]
  177. Perez Trallero E., Garcia Arenzana J. M., Urbieta Egaña M. Erythromycin resistance in streptococci. Lancet. 1989 Aug 19;2(8660):444–445. doi: 10.1016/s0140-6736(89)90618-1. [DOI] [PubMed] [Google Scholar]
  178. Perlino C. A., Burleigh P. Penicillin-insensitive pneumococci: isolation from patients with pneumonia. South Med J. 1979 Jan;72(1):20–22. [PubMed] [Google Scholar]
  179. Phillips G., Barker R., Brogan O. Optochin-resistant Streptococcus pneumoniae. Lancet. 1988 Jul 30;2(8605):281–281. doi: 10.1016/s0140-6736(88)92573-1. [DOI] [PubMed] [Google Scholar]
  180. Piddock L. J., Wise R. The selection and frequency of streptococci with decreased susceptibility to ofloxacin compared with other quinolones. J Antimicrob Chemother. 1988 Sep;22 (Suppl 100):45–51. doi: 10.1093/jac/22.supplement_c.45. [DOI] [PubMed] [Google Scholar]
  181. Pérez J. L., Linares J., Bosch J., López de Goicoechea M. J., Martín R. Antibiotic resistance of Streptococcus pneumoniae in childhood carriers. J Antimicrob Chemother. 1987 Feb;19(2):278–280. doi: 10.1093/jac/19.2.278. [DOI] [PubMed] [Google Scholar]
  182. RICHARDS J. D., RYCROFT J. A. Tetracycline-resistant pneumococci. Lancet. 1963 Mar 9;1(7280):553–553. doi: 10.1016/s0140-6736(63)91351-5. [DOI] [PubMed] [Google Scholar]
  183. Radetsky M. S., Istre G. R., Johansen T. L., Parmelee S. W., Lauer B. A., Wiesenthal A. M., Glode M. P. Multiply resistant pneumococcus causing meningitis: its epidemiology within a day-care centre. Lancet. 1981 Oct 10;2(8250):771–773. doi: 10.1016/s0140-6736(81)90184-7. [DOI] [PubMed] [Google Scholar]
  184. Ragsdale A. R., Sanford J. P. Interfering effect of incubation in carbon dioxide on the identification of pneumococci by optochin discs. Appl Microbiol. 1971 Nov;22(5):854–855. doi: 10.1128/am.22.5.854-855.1971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  185. Ramsay A. Meningitis secondary to multiply resistant Streptococcus pneumoniae. J Fam Pract. 1982 Jun;14(6):1041–1044. [PubMed] [Google Scholar]
  186. Roberts M. C., Moncla B. J. Tetracycline resistance and TetM in oral anaerobic bacteria and Neisseria perflava-N. sicca. Antimicrob Agents Chemother. 1988 Aug;32(8):1271–1273. doi: 10.1128/aac.32.8.1271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  187. Robins-Brown R. M., Gaspar M. N., Ward J. I., Wachsmuth I. K., Koornhof H. J., Jacobs M. R., Thornsberry C. Resistance mechanisms of multiply resistant pneumococci: antibiotic degradation studies. Antimicrob Agents Chemother. 1979 Mar;15(3):470–474. doi: 10.1128/aac.15.3.470. [DOI] [PMC free article] [PubMed] [Google Scholar]
  188. Robins-Browne R. M., Kharsany A. B., Koornhof H. J. Antibiotic-resistant pneumococci in hospitalized children. J Hyg (Lond) 1984 Aug;93(1):9–16. doi: 10.1017/s0022172400060873. [DOI] [PMC free article] [PubMed] [Google Scholar]
  189. SCHAEDLER R. W., CHOPPIN P. W., ZABRISKIE J. B. PNEUMONIA CAUSED BY TETRACYCLINE-RESISTANTPNEUMOCOCCI. N Engl J Med. 1964 Jan 16;270:127–129. doi: 10.1056/NEJM196401162700304. [DOI] [PubMed] [Google Scholar]
  190. Sacho H., Klugman K. P., Koornhof H. J., Ruff P. Community-acquired pneumonia in an adult due to a multiply-resistant pneumococcus. J Infect. 1987 Mar;14(2):188–189. doi: 10.1016/s0163-4453(87)92127-x. [DOI] [PubMed] [Google Scholar]
  191. Sanchez-Pescador R., Brown J. T., Roberts M., Urdea M. S. Homology of the TetM with translational elongation factors: implications for potential modes of tetM-conferred tetracycline resistance. Nucleic Acids Res. 1988 Feb 11;16(3):1218–1218. doi: 10.1093/nar/16.3.1218. [DOI] [PMC free article] [PubMed] [Google Scholar]
  192. Schaad U. B., McCracken G. H., Jr, Loock C. A., Thomas M. L. Pharmacokinetics and bacteriologic efficacy of moxalactam, cefotaxime, cefoperazone, and rocephin in experimental bacterial meningitis. J Infect Dis. 1981 Feb;143(2):156–163. doi: 10.1093/infdis/143.2.156. [DOI] [PubMed] [Google Scholar]
  193. Schaffner W., Schreiber W. M., Koenig M. G. Fatal pneumonia due to a tetracycline-resistant pneumococcus. N Engl J Med. 1966 Feb 24;274(8):451–452. doi: 10.1056/NEJM196602242740808. [DOI] [PubMed] [Google Scholar]
  194. Schneerson R., Robbins J. B., Parke J. C., Jr, Bell C., Schlesselman J. J., Sutton A., Wang Z., Schiffman G., Karpas A., Shiloach J. Quantitative and qualitative analyses of serum antibodies elicited in adults by Haemophilus influenzae type b and pneumococcus type 6A capsular polysaccharide-tetanus toxoid conjugates. Infect Immun. 1986 May;52(2):519–528. doi: 10.1128/iai.52.2.519-528.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  195. Shanholtzer C. J., Peterson L. R. False susceptible penicillin G MICs for Streptococcus pneumoniae with a commercial microdilution system. Am J Clin Pathol. 1986 May;85(5):626–629. doi: 10.1093/ajcp/85.5.626. [DOI] [PubMed] [Google Scholar]
  196. Shivakumar A. G., Dubnau D. Characterization of a plasmid-specified ribosome methylase associated with macrolide resistance. Nucleic Acids Res. 1981 Jun 11;9(11):2549–2562. doi: 10.1093/nar/9.11.2549. [DOI] [PMC free article] [PubMed] [Google Scholar]
  197. Shockley T. E., Hotchkiss R. D. Stepwise introduction of transformable penicillin resistance in Pneumococcus. Genetics. 1970 Mar-Apr;64(3):397–408. [PMC free article] [PubMed] [Google Scholar]
  198. Shoemaker N. B., Smith M. D., Guild W. R. Organization and transfer of heterologous chloramphenicol and tetracycline resistance genes in pneumococcus. J Bacteriol. 1979 Aug;139(2):432–441. doi: 10.1128/jb.139.2.432-441.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  199. Siegel J. D., Poziviak C. S., Michaels R. H. Serotypically defined pneumococcal infections in children. J Pediatr. 1978 Aug;93(2):249–250. doi: 10.1016/s0022-3476(78)80507-1. [DOI] [PubMed] [Google Scholar]
  200. Simberkoff M. S., Lukaszewski M., Cross A., Al-Ibrahim M., Baltch A. L., Smith R. P., Geiseler P. J., Nadler J., Richmond A. S. Antibiotic-resistant isolates of Streptococcus pneumoniae from clinical specimens: a cluster of serotype 19A organisms in Brooklyn, New York. J Infect Dis. 1986 Jan;153(1):78–82. doi: 10.1093/infdis/153.1.78. [DOI] [PubMed] [Google Scholar]
  201. Smith M. D., Guild W. R. A plasmid in Streptococcus pneumoniae. J Bacteriol. 1979 Feb;137(2):735–739. doi: 10.1128/jb.137.2.735-739.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  202. Smith M. D., Hazum S., Guild W. R. Homology among tet determinants in conjugative elements of streptococci. J Bacteriol. 1981 Oct;148(1):232–240. doi: 10.1128/jb.148.1.232-240.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  203. Snell J. J., George R. C., Perry S. F., Erdman Y. J. Antimicrobial susceptibility testing of Streptococcus pneumoniae: quality assessment results. J Clin Pathol. 1988 Apr;41(4):384–387. doi: 10.1136/jcp.41.4.384. [DOI] [PMC free article] [PubMed] [Google Scholar]
  204. Stassi D. L., Lopez P., Espinosa M., Lacks S. A. Cloning of chromosomal genes in Streptococcus pneumoniae. Proc Natl Acad Sci U S A. 1981 Nov;78(11):7028–7032. doi: 10.1073/pnas.78.11.7028. [DOI] [PMC free article] [PubMed] [Google Scholar]
  205. Stuart J. J., Ravin A. W. Levels of resistance in ribosomes from genetically linked, streptomycin-resistant mutants of pneumococcus. J Gen Microbiol. 1968 May;51(3):411–424. doi: 10.1099/00221287-51-3-411. [DOI] [PubMed] [Google Scholar]
  206. Swenson J. M., Hill B. C., Thornsberry C. Screening pneumococci for penicillin resistance. J Clin Microbiol. 1986 Nov;24(5):749–752. doi: 10.1128/jcm.24.5.749-752.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  207. TURNER G. C. TETRACYCLINE-RESISTANT PNEUMOCOCCI IN A GENERAL HOSPITAL. Lancet. 1963 Dec 21;2(7321):1292–1295. doi: 10.1016/s0140-6736(63)90845-6. [DOI] [PubMed] [Google Scholar]
  208. Tarpay M. M., Welch D. F., Marks M. I. Antimicrobial susceptibility testing of Streptococcus pneumoniae by micro-broth dilution. Antimicrob Agents Chemother. 1980 Oct;18(4):579–581. doi: 10.1128/aac.18.4.579. [DOI] [PMC free article] [PubMed] [Google Scholar]
  209. Tarpay M. M., Welch D. F., Salari H., Marks M. I. In vitro activity of antibiotics commonly used in the treatment of otitis media against Streptococcus pneumoniae isolates with different susceptibilities to penicillin. Antimicrob Agents Chemother. 1982 Jul;22(1):145–147. doi: 10.1128/aac.22.1.145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  210. Tarpay M. Importance of antimicrobial susceptibility testing of Streptococcus pneumoniae. Antimicrob Agents Chemother. 1978 Oct;14(4):628–629. doi: 10.1128/aac.14.4.628. [DOI] [PMC free article] [PubMed] [Google Scholar]
  211. Teele D. W., Pelton S. I., Klein J. O. Bacteriology of acute otitis media unresponsive to initial antimicrobial therapy. J Pediatr. 1981 Apr;98(4):537–539. doi: 10.1016/s0022-3476(81)80755-x. [DOI] [PubMed] [Google Scholar]
  212. Tempest B., Carney J. P., Eberle B. Distribution of the sensitivities to penicillin of types of Diplococcus pneumoniae in an American Indian population. J Infect Dis. 1974 Jul;130(1):67–69. doi: 10.1093/infdis/130.1.67. [DOI] [PubMed] [Google Scholar]
  213. Tomasz A., Moreillon P., Pozzi G. Insertional inactivation of the major autolysin gene of Streptococcus pneumoniae. J Bacteriol. 1988 Dec;170(12):5931–5934. doi: 10.1128/jb.170.12.5931-5934.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  214. Tuomanen E., Pollack H., Parkinson A., Davidson M., Facklam R., Rich R., Zak O. Microbiological and clinical significance of a new property of defective lysis in clinical strains of pneumococci. J Infect Dis. 1988 Jul;158(1):36–43. doi: 10.1093/infdis/158.1.36. [DOI] [PubMed] [Google Scholar]
  215. Tweardy D. J., Jacobs M. R., Speck W. T. Susceptibility of penicillin-resistant pneumococci to eighteen antimicrobials: implications for treatment of meningitis. J Antimicrob Chemother. 1983 Aug;12(2):133–139. doi: 10.1093/jac/12.2.133. [DOI] [PubMed] [Google Scholar]
  216. Täuber M. G., Doroshow C. A., Hackbarth C. J., Rusnak M. G., Drake T. A., Sande M. A. Antibacterial activity of beta-lactam antibiotics in experimental meningitis due to Streptococcus pneumoniae. J Infect Dis. 1984 Apr;149(4):568–574. doi: 10.1093/infdis/149.4.568. [DOI] [PubMed] [Google Scholar]
  217. Täuber M. G., Hackbarth C. J., Scott K. G., Rusnak M. G., Sande M. A. New cephalosporins cefotaxime, cefpimizole, BMY 28142, and HR 810 in experimental pneumococcal meningitis in rabbits. Antimicrob Agents Chemother. 1985 Mar;27(3):340–342. doi: 10.1128/aac.27.3.340. [DOI] [PMC free article] [PubMed] [Google Scholar]
  218. Täuber M. G., Zak O., Scheld W. M., Hengstler B., Sande M. A. The postantibiotic effect in the treatment of experimental meningitis caused by Streptococcus pneumoniae in rabbits. J Infect Dis. 1984 Apr;149(4):575–583. doi: 10.1093/infdis/149.4.575. [DOI] [PubMed] [Google Scholar]
  219. Vijayakumar M. N., Priebe S. D., Guild W. R. Structure of a conjugative element in Streptococcus pneumoniae. J Bacteriol. 1986 Jun;166(3):978–984. doi: 10.1128/jb.166.3.978-984.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  220. Vijayakumar M. N., Priebe S. D., Pozzi G., Hageman J. M., Guild W. R. Cloning and physical characterization of chromosomal conjugative elements in streptococci. J Bacteriol. 1986 Jun;166(3):972–977. doi: 10.1128/jb.166.3.972-977.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  221. Viladrich P. F., Gudiol F., Liñares J., Rufi G., Ariza J., Pallares R. Characteristics and antibiotic therapy of adult meningitis due to penicillin-resistant pneumococci. Am J Med. 1988 May;84(5):839–846. doi: 10.1016/0002-9343(88)90061-7. [DOI] [PubMed] [Google Scholar]
  222. WOLF B., HOTCHKISS R. D. Genetically modified folic acid synthesizing enzymes of pneumococcus. Biochemistry. 1963 Jan-Feb;2:145–150. doi: 10.1021/bi00901a026. [DOI] [PubMed] [Google Scholar]
  223. Wall R. A., Emmerson A. M., Lamport P. Penicillin-resistant pneumococci in London. Lancet. 1981 Jul 18;2(8238):148–148. doi: 10.1016/s0140-6736(81)90325-1. [DOI] [PubMed] [Google Scholar]
  224. Wamola I. A., Mirza N. B., Nsanzumukhire H. Penicillin resistant pneumococcal meningitis in Kenyatta National Hospital, Nairobi, Kenya. East Afr Med J. 1981 Jan;58(1):12–17. [PubMed] [Google Scholar]
  225. Ward J. I., Moellering R. C., Jr Susceptibility of pneumococci to 14 beta-lactam agents: comparison of strains resistant, intermediate-resistant, and susceptible to penicillin. Antimicrob Agents Chemother. 1981 Aug;20(2):204–207. doi: 10.1128/aac.20.2.204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  226. Ward J. Antibiotic-resistant Streptococcus pneumoniae: clinical and epidemiologic aspects. Rev Infect Dis. 1981 Mar-Apr;3(2):254–266. doi: 10.1093/clinids/3.2.254. [DOI] [PubMed] [Google Scholar]
  227. Williams E. W., Watts J. A., Potten M. R. Streptococcus pneumoniae resistant to penicillin and chloramphenicol in the U.K. Lancet. 1981 Sep 26;2(8248):699–699. doi: 10.1016/s0140-6736(81)91036-9. [DOI] [PubMed] [Google Scholar]
  228. Williamson R., Tomasz A. Inhibition of cell wall synthesis and acylation of the penicillin binding proteins during prolonged exposure of growing Streptococcus pneumoniae to benzylpenicillin. Eur J Biochem. 1985 Sep 16;151(3):475–483. doi: 10.1111/j.1432-1033.1985.tb09126.x. [DOI] [PubMed] [Google Scholar]
  229. Wood N. G. A survey of isolates of Streptococcus pneumoniae. N Z Med J. 1976 Mar 10;83(559):154–155. [PubMed] [Google Scholar]
  230. Wüst J., Kayser F. H., Morenzoni G. Antimikrobielle Resistenz und Serotypen von Streptococcus pneumoniae in Zürich (1984/1985). Schweiz Med Wochenschr. 1987 Jun 6;117(23):868–873. [PubMed] [Google Scholar]
  231. Zackrisson G., Brorson J. E. Antibiotic sensitivity pattern of recent clinical isolates of Streptococcus pneumoniae. Acta Pathol Microbiol Scand B. 1981 Feb;89(1):25–28. doi: 10.1111/j.1699-0463.1981.tb00147_89b.x. [DOI] [PubMed] [Google Scholar]
  232. Zighelboim S., Tomasz A. Penicillin-binding proteins of multiply antibiotic-resistant South African strains of Streptococcus pneumoniae. Antimicrob Agents Chemother. 1980 Mar;17(3):434–442. doi: 10.1128/aac.17.3.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  233. el-Mouzan M. I., Twan-Danso K., Al-Awamy B. H., Niazi G. A., Altorki M. T. Pneumococcal infections in eastern Saudi Arabia: serotypes and antibiotic sensitivity patterns. Trop Geogr Med. 1988 Jul;40(3):213–217. [PubMed] [Google Scholar]
  234. van den Ende J., Rotter M. L. An analysis of blood culture isolates from 7 South African teaching hospital centres. S Afr Med J. 1986 Jan 18;69(2):89–93. [PubMed] [Google Scholar]

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