The study population included children <24 months of age who were residents of the Negev region and had OM judged to necessitate middle ear fluid (MEF) culture. Cultures were obtained by tympanocentesis or by swab of the external canal of children with acute (<7 days) spontaneous otorrhea. Most of the children had complex OM (nonresponsive, recurrent, spontaneous perforation, or chronic ear effusion) (7,12,13). Children found to have pneumococcal MEF isolates during 2009–2017 were included (7).

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