Figure 1a.

Study flowchart for enrollment.S. pneumoniae isolates were collected by both prospective and retrospective phases; 300 isolates were eligible [children: 148 (49.3%), adults: 152 (50.7%)] and included for analysis. In the pediatric group, 102 (68.9%) isolates were collected via retrospective phase and 46 (31.1%) via prospective phase; in the adult group, 93 (61.2%) were collected via retrospective phase and 59 (38.8%) via prospective phase;Laboratory issues included isolate death or loss in the central laboratory.Geographic distribution of study sites in China.The study collected S. pneumonia isolates from 27 sites located in 13 provinces in China. A total of 149 isolates were from the North region and 151 isolates were from the South region. Provinces in the North region: Beijing, Gansu, Hebei, Jiangsu (north), Liaoning, Shandong, Shanxi, and Tianjin; provinces in the South region: Anhui, Hainan, Hubei, Jiangsu (south), Shanghai, and Zhejiang