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, 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,

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