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In response to the selective pressure of pneumococcal conjugate vaccine, increased asymptomatic carriage of antibiotic-nonsusceptible nonvaccine serotypes (NVTs) has been observed. Possible mechanisms include de novo acquisition of resistance, serotype switching, introduction of new clones, and expansion of existing clones.

the journal of infectious diseases (online. university of chicago press)/the journal of infectious diseases

Diversity and Antibiotic Resistance among Nonvaccine Serotypes of<i>Streptococcus pneumoniae</i>Carriage Isolates in the Post–Heptavalent Conjugate Vaccine Era

Diversity and Antibiotic Resistance among Nonvaccine Serotypes ofStreptococcus pneumoniaeCarriage Isolates in the Post–Heptavalent Conjugate Vaccine Era