Breakthrough bacteraemia with a susceptible Enterococcus faecalis during tigecycline monotherapy.

to ,2 years fluctuated within the range of 20%–30%, with no significant overall change in trend [OR1⁄41.02; 95% confidence interval (CI)1⁄40.97–1.08]. In contrast, the resistance rates in older patients ranged from 12% to 14% between 2000 and 2004, with a gradual decrease from 2004 onwards. This decrease followed the national introduction in 2003 of a 23-valent pneumococcal polysaccharide vaccine (23vPPV) recommended for use in people aged 65 years and for younger patients (.2 years old) at high risk of pneumococcal infection. This vaccination programme was an expansion of the previous policy that was implemented in England in 1992, where only specific risk groups were included. Following the introduction of PCV7 in late 2006, there was a significant reduction in erythromycin resistance in children aged 2 months to ,2 years, from 24% in 2006 to 3% in 2009 (OR1⁄40.42; 95% CI1⁄40.30–0.58) (Figure 1). Due to the decreasing level of resistance already evident in isolates from older patients prior to 2006, it is difficult to assess the extent of any potential herd immunity in these patients resulting from the use of PCV7 in those aged ,2 years. This study documents the steep fall in erythromycin resistance amongst invasive pneumococci from children aged ,2 years after the introduction of PCV7. Clearly, further surveillance is required to assess future trends in resistance amongst pneumococci isolated from patients of various ages, and to monitor potential re-emergence of erythromycin resistance, possibly due to increased spread of pneumococcal serotypes currently not included in the vaccine.