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Background  The etiology and epidemiology of acute otitis media (AOM) are poorly understood in China. This study aimed to describe the etiology of AOM and the phenotypic and molecular characteristics of AOM-causing  Streptococcus pneumoniae  ( S.pneumoniae ) recovered from Chinese children.    Methods  A retrospective study was conducted to enrol patients younger than 18 years diagnosed as AOM. Middle ear fluid specimens were collected then cultured for bacterial pathogens. All  S.pneumoniae  isolates were tested for antibiotic susceptibility, serotypes, virulence genes, antibiotic resistant determinants and sequence types.    Results  The dominant otopathogen among AOM children was  S.pneumoniae  (54.4%). Among  S.pneumoniae  isolates, there were 97.3, 97.3 and 75.7% isolates resistant to erythromycin, tetracycline and trimethoprim-sulfamethoxazole, respectively. There was 72.8%  S.pneumoniae  with multidrug resistance. The dominant sequence types (STs) were ST271 and ST320, whereas the prevailing serotypes were 19F and 19A. The 7-valent and 13-valent pneumococcal conjugate vaccine (PCV) coverage among AOM children were 73.0 and 94.6%, respectively. Additionally, we found that CC271 expressed more of  mef (A/E) ( P  < 0.001),  pspA  ( P  = 0.022) and  sipA  ( P  < 0.001) than non-CC271 isolates.    Conclusion  The high prevalence of international multidrug-resistant clone (Taiwan 19F -14) in China necessitates continued dedication to expand PCV13 immunization and better control of antibiotic use in China.

Etiology of acute otitis media and phenotypic-molecular characterization of Streptococcus pneumoniae isolated from children in Liuzhou, China