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Multicenter Study
. 2025 Aug 5;25(1):980.
doi: 10.1186/s12879-025-11377-5.

Distribution of serotypes and antibiotic resistance profiles of Streptococcus pneumoniae in hospitalized adult patients: aretrospective multicenter surveillance in China (2018-2019)

Chunjiang Zhao  1 , Feifei Zhang  1 , Zhanwei Wang  1 , Shuo Yang  1 , Hongbin Chen  1 , Hui Wang  2
Affiliations
Multicenter Study

Distribution of serotypes and antibiotic resistance profiles of Streptococcus pneumoniae in hospitalized adult patients: aretrospective multicenter surveillance in China (2018-2019)

Chunjiang Zhao et al. BMC Infect Dis. .

Abstract

Background: Streptococcus pneumoniae (S. pneumoniae) remains a major cause of community acquired pneumonia (CAP), particularly among older adults. In China, pneumococcal infections pose a substantial disease burden, with rising antibiotic resistance. Although vaccines have effectively reduced disease worldwide, data on adult serotype distribution and resistance in China are scarce. This study investigates serotype patterns and antimicrobial susceptibility of S. pneumoniae among Chinese adults.

Methods: We collected a total of 474 S. pneumoniae isolates from adult patients diagnosed with pneumococcal infections in 14 cities across five geographic regions of China between 2018 and 2019. Clinical specimens included sputum, blood, bronchoalveolar lavage fluid (BALF), cerebrospinal fluid (CSF), pharyngeal and nasal swabs, and middle ear fluid. Minimum inhibitory concentrations (MICs) of antimicrobial agents were determined using the agar dilution method. Pneumococcal serotyping was performed using the Pneumotest-Latex kit and type-specific antisera.

Results: Serotype 19F was the most prevalent across all age groups, specimen types, and regions. 20-valent pneumococcal conjugate vaccine (PCV20) is expected to provide the highest serotype coverage (69.4%) among all vaccines evaluated. Multidrug resistance was detected in over 94% of isolates, with high resistance to macrolides, tetracycline, and clindamycin. β-lactam resistance varied by syndrome and region. Non-invasive isolates showed slightly higher resistance than invasive ones. Serotypes covered by higher-valency vaccines were more likely to be antibiotic-resistant, although fluoroquinolone and vancomycin resistance remained low.

Conclusions: Our findings highlight a high burden of antimicrobial resistance and predominance of specific serotypes, particularly 19F, among adult S. pneumoniae isolates in China. The broad serotype coverage of PCV20 suggests its potential advantage in future adult immunization strategies. Continued surveillance of serotype distribution and resistance patterns is essential to inform vaccine policy and guide effective antibiotic use.

Keywords: Streptococcus pneumoniae; Adult; Antimicrobial resistance; China; PCV20; Pneumococcal conjunctive vaccine; Serotype.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of Peking University People’s Hospital (approval No. 2018PHB129) and conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was waived due to the retrospective nature of the study and the use of anonymized data, as approved by the Institutional Review Board of Ethics Committee of Peking University People’s Hospital. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of 20 general hospitals included in the study
Fig. 2
Fig. 2
Serotype distribution of S.p isolates
Fig. 3
Fig. 3
Serotype distribution of S.p isolates
Fig. 4
Fig. 4
Antibiotic resistance of S. pneumoniae by regions
Fig. 5
Fig. 5
Antibiotic resistance of S. pneumoniae by disease category
Fig. 6
Fig. 6
Antibiotic resistance of S. pneumoniae by vaccine types
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