ECRTD test allowed differentiation of these strains into cMLSB and iMcLSB phenotypes. These data confirmed that double disk test appears to be less applicable for S. pneumoniae strains because pneumococci with MLSB phenotype, sellckchem carrying the erm(B) gene, are resistant to clindamycin without induction. Inducibility in pneumococci regards macrolides (particularly 16 membered ones, with emphasis on rokitamycin) but not lincosamides [10, 36].Each DCC can be regarded as independent microenvironment responsible for the specific acquisition and spread of pneumococci [7, 9]. We found differences among the DCCs concerning most of the serotypes, antibiotic resistance, and genotypic patterns. A few serotypes (9V,18C, 15) were typical only for one DCC. We observed different levels of antibiotic resistance in each DCC: the highest in DCC4.

After genetic analysis, it was shown that the differences depended on presence of particular strains circulating in single DCC in one or more seasons. Strains with the same phenotypes were homogenous within one DCC, but they yielded different BOX genotype for each DCC.BOX-PCR method possesses high discriminate power, and, because of this capacity, it is useful for comparison many strains from the same population [37]. Several studies concerning analysis of S. pneumoniae isolated from healthy children attending DCCs have been done with applying molecular typing in other country [9, 32] and suggested that each DCC may be considered as an autonomous epidemiological unit where the epidemic resistant clones of S. pneumoniae appeared and spread.

Data presented in this paper confirm that DCC environment facilitates person-to-person transmission of pneumococci, especially drug resistant strains, and may serve as a reservoir of drug-resistant strains, hence augmenting their carriage in the community.The World Health Organization (WHO) considers immunization of infants and young children with pneumococcal vaccines a priority. Carfilzomib Data published by other authors suggested that vaccination could potentially reduce the carriage rate of antibiotic-resistant pneumococci in Europe [31]. Currently, in Poland, both 23-valent polysaccharide vaccine for children ��2 years old and adults (since 1996) as well as pneumococcal conjugate vaccines PCV7 (since 2006), PCV10 (since 2009), and PCV13 (since 2010) for children ��2 years old have been recommended in the national immunization schedule.