Nasopharyngeal samples were obtained as previously described (9). In brief, we used a flexible Dacron-tipped swab, introduced through the nostrils. These swabs were inoculated into modified Stewart transport medium (Medical Wire and Equipment Co., Ltd, https://www.mwe.co.uk) and were processed within 16 hours at SUMC’s clinical microbiology laboratory. Material from swabs was plated on Columbia agar with 5% sheep blood and 5.0 mg/mL gentamicin and incubated for 48 h.

We presumptively identified S. pneumoniae on the basis of the presence of α-hemolysis and inhibition by optochin; we confirmed the identity of the bacteria present by a positive slide agglutination test result (Phadebact; MKL Diagnostics AB, http://www.mkldiagnostics.com).

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