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               <mods:identifier type="citation">J Antimicrob Chemother. 2022 Mar 31;77(4):1045-1051.</mods:identifier>
               <mods:identifier type="doi">10.1093/jac/dkab482</mods:identifier>
               <mods:identifier type="e-issn">1460-2091</mods:identifier>
               <mods:identifier type="journal">The Journal of antimicrobial chemotherapy</mods:identifier>
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               <mods:abstract>Background: Surveillance studies including antibiotic resistance and evolution of pneumococcal serotypes are critical to evaluate the susceptibility of commonly used antibiotics and the contribution of conjugate vaccines against resistant strains. Objectives: To determine the susceptibility of clinical isolates of Streptococcus pneumoniae with reduced susceptibility to penicillin to a panel of antibiotics during the period 2004-20 and characterize the impact of pneumococcal conjugate vaccines in the evolution of resistant serotypes. Methods: We selected 3017 clinical isolates in order to determine the minimal inhibitory concentration to penicillin, amoxicillin, cefotaxime, erythromycin, levofloxacin and oral cephalosporins, including cefditoren, cefixime and cefpodoxime. Results: The antibiotics with the lowest proportion of resistant strains from 2004 to 2020 were cefditoren (&lt;0.4%), followed by cefotaxime (&lt;5%), penicillin (&lt;6.5%) and levofloxacin (&lt;7%). Among oral cephalosporins, cefixime was the cephalosporin with the highest MIC90 (32 mg/L) and MIC50 (8-16 mg/L) throughout the study, followed by cefpodoxime with highest values of MIC90 (4 mg/L) and MIC50 (2 mg/L) for the majority of the study period. In contrast, cefditoren was the cephalosporin with the lowest MIC90 (1 mg/L) and MIC50 (0.25-0.5 mg/L). Conclusions: Cefditoren was the antibiotic with the highest proportion of susceptible strains. Hence, more than 80% of the clinical strains were susceptible to cefditoren throughout the period 2004-20. The proportion of resistant isolates to cefditoren and cefotaxime was scarce, being less than 0.4% for cefditoren and lower than 5% for cefotaxime, despite the increased rates of serotypes not covered by the 13-valent pneumococcal conjugate vaccine.</mods:abstract>
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                  <mods:title>A national longitudinal study evaluating the activity of cefditoren and other antibiotics against non-susceptible Streptococcus pneumoniae strains during the period 2004-20 in Spain</mods:title>
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