9% in 2003 to 20.0% in 2007 has selleck chemical been described . An increased awareness of IPD among adults has been observed since 2007. This correlates to the general recommendation of pneumococcal conjugate vaccination for children < 2 years in learn more Germany at the end of July 2006 and an increased interest in serotype information of IPD. Furthermore, in January 2007 an
internet based laboratory sentinel system (‘PneumoWeb’) was established in Germany, which enables participating laboratories to transfer anonymised basic patient information on a voluntary basis. Compared to children, only a minor reduction of nonsusceptibility has been observed among adults from 2005 (18.6%) to 2008 (13.0%), although this reduction was also statistically significant. Possible reasons for the decrease in macrolide nonsusceptibility include a reduced macrolide consumption due to the rising resistance rates, as well as the general recommendation of pneumococcal conjugate selleck chemicals vaccination for children < 2 years in Germany at the end of July 2006. Since the introduction of the vaccine a considerable decrease of serotypes included in the 7-valent
pneumococcal conjugate vaccine has been observed among German children, but also (to a lesser extent) among adults , which is partly due to the association of serotypes with age [19, 20]. The antibiotic prescribing practices, which are thought to be among the most significant drivers for the spread of
pneumococcal resistance, differ vastly between European countries [15, 21–23]. A decrease in the use of macrolides has been reported for instance in Spain , Portugal [24, 25], Belgium , Slovenia  and Taiwan Olopatadine [28, 29]. The influence of a decreased macrolide consumption on macrolide susceptibility is discussed controversially. In Spain a relation between the decrease in macrolide consumption and the decrease in erythromycin non-susceptibility among children could be shown, while this effect was absent among the adult population, probably due to the increase in non-vaccine serotypes such as 19A (from 3.6% of all invasive serotypes in 2000 to 10.1% in 2007) . Reports from other countries showed no decrease in macrolide nonsusceptibility following a reduced macrolide consumption [25–29]. Besides the total macrolide consumption, the influence of long lasting macrolides, which may increase even in times of decreasing total macrolide consumption , is discussed to be a cause of the macrolide nonsusceptibility [25, 30–32]. Besides antibiotics, pneumococcal conjugate vaccination is another important factor associated with changes in macrolide susceptibility [25, 26, 33–36]. In our study, high rates of serotype specific resistance among the more frequent serotypes were observed among the serotypes 14, 6B, 19F and 23F, in particular.