<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2617-4731</journal-id>
<journal-title><![CDATA[Revista de la Sociedad Científica del Paraguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Soc. cient. Parag.]]></abbrev-journal-title>
<issn>2617-4731</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Científica del Paraguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2617-47312018000200263</article-id>
<article-id pub-id-type="doi">10.32480/rscp.2018-23-2.263-274</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Streptococcus pneumoniae causante de enfermedad neumocócica invasivas en adultos. Paraguay (2013-2018)]]></article-title>
<article-title xml:lang="en"><![CDATA[Streptococcus pneumoniae causative of invasive pneumococcal disease in adults. Paraguay (2013-2018)]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[León]]></surname>
<given-names><![CDATA[María E.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Kawabata]]></surname>
<given-names><![CDATA[Anibal]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Nagai]]></surname>
<given-names><![CDATA[Minako]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rojas]]></surname>
<given-names><![CDATA[Liliana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Chamorro]]></surname>
<given-names><![CDATA[Gustavo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gómez]]></surname>
<given-names><![CDATA[Gloria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Leguizamón]]></surname>
<given-names><![CDATA[Miriam]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Irala]]></surname>
<given-names><![CDATA[Juan]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ortiz]]></surname>
<given-names><![CDATA[Helena]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Franco]]></surname>
<given-names><![CDATA[Rossana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Segovia]]></surname>
<given-names><![CDATA[Nancy]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Laboratorio Central de Salud Pública  ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Nacional de Itauguá  ]]></institution>
<addr-line><![CDATA[Itauguá ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto de Previsión Social  ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Instituto de Medicina Tropical  ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Hospital de Clínicas  ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,INERAM  ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af7">
<institution><![CDATA[,Hospital Regional Ciudad del Este  ]]></institution>
<addr-line><![CDATA[Ciudad del Este ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2018</year>
</pub-date>
<volume>23</volume>
<numero>2</numero>
<fpage>263</fpage>
<lpage>274</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2617-47312018000200263&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2617-47312018000200263&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2617-47312018000200263&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen Se describe la frecuencia de aislamientos de S. pneumoniae causante de enfermedad neumocócica invasiva (ENI) en adultos, la distribución de los serotipos y su sensibilidad antimicrobiana en Paraguay durante el periodo 2013-2018. Se trata de un estudio descriptivo observacional retrospectivo de corte transversal en el que se estudiaron un total de 269 cepas de S. pneumoniae aisladas en líquido cefalorraquídeo (LCR) (76/269), líquido pleural (174/269) y hemocultivo 19/269), provenientes de los diferentes centros centinelas y colaboradores de la vigilancia de meningitis y neumonías bacterianas en Paraguay durante el periodo 2013 a setiembre de 2018. Se halló que el 28.0% de los casos correspondieron a meningitis bacteriana aguda (MBA) (76/269), 65.0% a neumonías (174/269) y 7.0% a sepsis (19/269). Se observó una mayor frecuencia de casos en adultos mayores de 60 años en MBA 29.0%, en neumonías 46.0% y en sepsis 42.0%. Los serotipos más frecuentes fueron el 3 con 13.0% (34/269), el 19A 10.0% (26/269), el 14 con 5.0% (12/269), el 12F con 4.0% (11/269) y los NT con 6.0% (16/269). Se encontraron 43/269 (15.0%) serotipos incluidos en la PCV10, 118/269 (44.0%) incluidos en la PCV13 y 165/269 (61.0%) incluidos en la PCV23. En los casos de meningitis se detectaron 20 aislamientos de S. pneumoniae resistentes a penicilina (38.5%). Se concluye que es necesaria una vigilancia epidemiológica continua para evaluar la carga de enfermedad y medir la efectividad de la vacuna en esta población para comprender la plena magnitud de la ENI en Paraguay, incluyendo su impacto económico, y definir estrategias eficaces para prevenirla.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Aim. Describe the frequency of S. pneumoniae isolates that cause invasive pneumococcal disease (ENI) in adults, the distribution of serotypes and their antimicrobial sensitivity in Paraguay during the period 2013-2018. The approach conforms a cross-sectional retrospective observational descriptive study in which a total of 269 strains of S. pneumoniae isolated in cerebrospinal fluid (CSF) (76/269), pleural fluid (174/269) and blood culture 19/269) were studied. the different sentinel centers and collaborators of the surveillance of bacterial meningitis and pneumonias in Paraguay during the period 2013 to September 2018. It was found that 28.0% of the cases corresponded to acute bacterial meningitis (MBA) (76/269), 65.0% to pneumonias (174/269) and 7.0% to sepsis (19/269). A higher frequency of cases was observed in adults over 60 years of age in MBA 29.0%, in pneumonia 46.0% and in sepsis 42.0%. The most frequent serotypes were 3 with 13.0% (34/269), 19A 10.0% (26/269), 14 with 5.0% (12/269), 12F with 4.0% (11/269) and NT with 6.0% (16/269). We found 43/269 (15.0%) serotypes included in PCV10, 118/269 (44.0%) included in PCV13 and 165/269 (61.0%) included in PCV23. In the cases of meningitis, they were detected 20 isolates of S. pneumoniae resistant to penicillin (38.5%). It can be conclude that continuous epidemiological surveillance is needed to assess the burden of disease and measure the impact of the vaccine in this population to understand the full magnitude of the ENI in Paraguay, including its economic impact, and define effective strategies to prevent it.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Streptococcus pneumoniae]]></kwd>
<kwd lng="es"><![CDATA[enfermedadneumocócicainvasiva]]></kwd>
<kwd lng="es"><![CDATA[adultos]]></kwd>
<kwd lng="es"><![CDATA[Paraguay]]></kwd>
<kwd lng="en"><![CDATA[Streptococcus pneumoniae]]></kwd>
<kwd lng="en"><![CDATA[invasive pneumococcal disease]]></kwd>
<kwd lng="en"><![CDATA[adults]]></kwd>
<kwd lng="en"><![CDATA[Paraguay]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Morrill]]></surname>
<given-names><![CDATA[HJ]]></given-names>
</name>
<name>
<surname><![CDATA[Caffrey]]></surname>
<given-names><![CDATA[AR]]></given-names>
</name>
<name>
<surname><![CDATA[Noh]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[LaPlante]]></surname>
<given-names><![CDATA[KL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Epidemiology of Pneumococcal Disease in a National Cohort of Older Adults]]></article-title>
<source><![CDATA[Infect Dis Ther]]></source>
<year>2014</year>
<volume>3</volume>
<page-range>19-33</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Carmona-Furusho]]></surname>
<given-names><![CDATA[LK]]></given-names>
</name>
<name>
<surname><![CDATA[Ariza-Andraca]]></surname>
<given-names><![CDATA[CR]]></given-names>
</name>
<name>
<surname><![CDATA[Iniestra-Flores]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Soto-Hernández]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Meningitis fulminante por Streptococcus pneumoniae. A propósito de tres casos]]></article-title>
<source><![CDATA[Rev Med Inst Mex Seguro Soc]]></source>
<year>2006</year>
<volume>44</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>71-7</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Said]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Johnson]]></surname>
<given-names><![CDATA[HL]]></given-names>
</name>
<name>
<surname><![CDATA[Nonyane]]></surname>
<given-names><![CDATA[BA]]></given-names>
</name>
<name>
<surname><![CDATA[Deloria-Knoll]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[O'Brien]]></surname>
<given-names><![CDATA[KL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques]]></article-title>
<source><![CDATA[PLoS One]]></source>
<year>2013</year>
<volume>8</volume>
<numero>4</numero>
<issue>4</issue>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Earle]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Williams]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Burden of pneumococcal disease in adults aged 65 years and older: an Australian perspective]]></article-title>
<source><![CDATA[Pneumonia (Nathan)]]></source>
<year>2016</year>
<volume>8</volume>
<numero>9</numero>
<issue>9</issue>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bosch]]></surname>
<given-names><![CDATA[AATM]]></given-names>
</name>
<name>
<surname><![CDATA[Biesbroek]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Trzcinski]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Sanders]]></surname>
<given-names><![CDATA[EAM]]></given-names>
</name>
<name>
<surname><![CDATA[Bogaert]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Viral and Bacterial Interactions in the Upper Respiratory Tract]]></article-title>
<source><![CDATA[PLoS Pathog.]]></source>
<year>2013</year>
<volume>9</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[KH]]></given-names>
</name>
<name>
<surname><![CDATA[Gordon]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Foxman]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The role of respiratory viruses in the etiology of bacterial pneumonia: an ecological perspective]]></article-title>
<source><![CDATA[Evol Med Public Health.]]></source>
<year>2016</year>
<numero>1</numero>
<issue>1</issue>
<page-range>95-109</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mishal]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Embon]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Darawshe]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Kidon]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Magen]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Community acquired acute bacterial meningitis in children and adults: an 11-year survey in a community hospital in Israel]]></article-title>
<source><![CDATA[Eur. J. Intern. Med.]]></source>
<year>2008</year>
<volume>19</volume>
<page-range>421-6</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Brouwer]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Tunkel]]></surname>
<given-names><![CDATA[AR]]></given-names>
</name>
<name>
<surname><![CDATA[van de Beek]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis]]></article-title>
<source><![CDATA[Clinical Microbiology Reviews]]></source>
<year>2010</year>
<volume>23</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>467-92</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mamishi]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Moradkhani]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Mahmoudi]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Hosseinpour-Sadeghi]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Pourakbari]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Penicillin- Resistant trend of Streptococcus pneumoniae in Asia: A systematic review]]></article-title>
<source><![CDATA[Iran J Microbiol.]]></source>
<year>2014</year>
<volume>6</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>198-210</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Medeiros]]></surname>
<given-names><![CDATA[MIC]]></given-names>
</name>
<name>
<surname><![CDATA[Almeida]]></surname>
<given-names><![CDATA[SCG]]></given-names>
</name>
<name>
<surname><![CDATA[Bokermann]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Watanabe]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Guerra]]></surname>
<given-names><![CDATA[MLL]]></given-names>
</name>
<name>
<surname><![CDATA[Andrade]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Antimicrobial susceptibility of Streptococcus pneumoniae isolated from patients in the northeastern macroregion of São Paulo state, Brazil, 1998-2013]]></article-title>
<source><![CDATA[J. Bras. Patol. Med. Lab.]]></source>
<year>2017</year>
<volume>53</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>177-82</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tricarico]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[McNeil]]></surname>
<given-names><![CDATA[HC]]></given-names>
</name>
<name>
<surname><![CDATA[Cleary]]></surname>
<given-names><![CDATA[DW]]></given-names>
</name>
<name>
<surname><![CDATA[Head]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Victor Lim]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Seng Yap]]></surname>
<given-names><![CDATA[IK]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pneumococcal conjugate vaccine implementation in middle-income countries]]></article-title>
<source><![CDATA[Pneumonia]]></source>
<year>2017</year>
<volume>9</volume>
<page-range>6</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Carvalho]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Tondella]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
<name>
<surname><![CDATA[Mc Caustland]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Weidlich]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[McGee]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Mayer]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evaluation and improvement of real-time PCR assays targeting lytA, ply, and psaA genes for detection of pneumococcal DNA]]></article-title>
<source><![CDATA[J Clin Microbiol]]></source>
<year>2007</year>
<volume>45</volume>
<page-range>2460-6</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Carvalho]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Pimenta]]></surname>
<given-names><![CDATA[FC]]></given-names>
</name>
<name>
<surname><![CDATA[Jackson]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Roundtree]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Ahmad]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Millar]]></surname>
<given-names><![CDATA[EV]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Revisiting pneumococcal carriage by use of broth enrichment and PCR techniques for enhanced detection of carriage and serotypes]]></article-title>
<source><![CDATA[J Clin Microbiol]]></source>
<year>2010</year>
<volume>48</volume>
<page-range>1611-8</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="book">
<collab>CDC</collab>
<source><![CDATA[Active Bacterial Core surveillance report, Emerging Infections Program Network, Streptococcus pneumoniae, 2010.]]></source>
<year>2011</year>
<publisher-loc><![CDATA[Atlanta, GA ]]></publisher-loc>
<publisher-name><![CDATA[US Department of Health and Human Services, CDC]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Weinberger]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Harboe]]></surname>
<given-names><![CDATA[ZB]]></given-names>
</name>
<name>
<surname><![CDATA[Sanders]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Ndiritu]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Klugman]]></surname>
<given-names><![CDATA[KP]]></given-names>
</name>
<name>
<surname><![CDATA[Ruckinger]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Association of serotype with risk of death due to pneumococcal pneumonia: a meta-analysis]]></article-title>
<source><![CDATA[Clin Infect Dis]]></source>
<year>2010</year>
<volume>51</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>692-9</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jansen]]></surname>
<given-names><![CDATA[AG]]></given-names>
</name>
<name>
<surname><![CDATA[Rodenburg]]></surname>
<given-names><![CDATA[GD]]></given-names>
</name>
<name>
<surname><![CDATA[van der Ende]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[van Alphen]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Veenhoven]]></surname>
<given-names><![CDATA[RH]]></given-names>
</name>
<name>
<surname><![CDATA[Spanjaard]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Invasive pneumococcal disease among adults: associations among serotypes, disease characteristics, and outcome]]></article-title>
<source><![CDATA[Clin Infect Dis]]></source>
<year>2009</year>
<volume>49</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>e23-9</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ciancotti Oliver]]></surname>
<given-names><![CDATA[LR]]></given-names>
</name>
<name>
<surname><![CDATA[Huertas Zarco]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Pérez Pérez]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Carmona Martí]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Carbó Malonda]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Gil Bru]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Enfermedad neumocócica invasiva en la Comunitat Valenciana. Seis años de vigilancia (2007-2012)]]></article-title>
<source><![CDATA[Enfermedades Infecciosas y Microbiología clínica]]></source>
<year>2015</year>
<volume>33</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>143-218</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Correa]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Sanz]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[de las Cuevas]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Guiu]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Domingo]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Alarcón]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bacteriemia neumocócica en pacientes adultos de un hospital de Madrid: serotipos y sensibilidad antibiótica]]></article-title>
<source><![CDATA[Rev Esp Quimioter]]></source>
<year>2012</year>
<volume>25</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>155-60</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Grabenstein]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
<name>
<surname><![CDATA[Musey]]></surname>
<given-names><![CDATA[LK]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Differences in serious clinical outcomes of infection caused by specific pneumococcal serotypes among adults]]></article-title>
<source><![CDATA[Vaccine. Vaccine]]></source>
<year>2014</year>
<volume>32</volume>
<numero>21</numero>
<issue>21</issue>
<page-range>2399-05</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="book">
<collab>Organización Panamericana de la Salud</collab>
<source><![CDATA[Informe Regional de SIREVA II, 2015. Datos por país y por grupos de edad sobre las características de los aislamientos de Streptococcus pneumoniae, Haemophilus influenzae y Neisseria meningitidis en procesos invasores. Documentos técnicos]]></source>
<year>2015</year>
<publisher-loc><![CDATA[Washington, D.C. ]]></publisher-loc>
<publisher-name><![CDATA[OPS]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Linares]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Ardanuy]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Pallares]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Fenoll]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Changes in antimicrobial resistance, serotypes and genotypes in Streptococcus pneumoniae over a 30-year period]]></article-title>
<source><![CDATA[Clin. Microbiol. Infect.]]></source>
<year>2010</year>
<volume>16</volume>
<page-range>402-10</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Yahiaoui]]></surname>
<given-names><![CDATA[RY]]></given-names>
</name>
<name>
<surname><![CDATA[Bootsma]]></surname>
<given-names><![CDATA[HJ]]></given-names>
</name>
<name>
<surname><![CDATA[den Heijer]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Pluister]]></surname>
<given-names><![CDATA[GN]]></given-names>
</name>
<name>
<surname><![CDATA[John Paget]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Spreeuwenberg]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Distribution of serotypes and patterns of antimicrobial resistance among commensal Streptococcus pneumoniae in nine European countries]]></article-title>
<source><![CDATA[BMC infectious diseases]]></source>
<year>2018</year>
<volume>18</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>440</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Isturiz]]></surname>
<given-names><![CDATA[RE]]></given-names>
</name>
<name>
<surname><![CDATA[Luna]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Ramirez]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical and economic burden of pneumonia among adults in Latin America]]></article-title>
<source><![CDATA[International Journal of Infectious Diseases]]></source>
<year>2010</year>
<volume>14</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>e852-6</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
