Three nationwide multicentre studies (n ¼ 5071) showed an increase in antibiotic resistance in pneumococci in Germany. Serotype 23F was the predominant serotype (n ¼ 45, 22·4 %), followed by 6B (n ¼ 30, 14·9 %) and 9V (n ¼ 19, 9·5 %). Multilocus sequence typing was used to characterize 45 serotype 23F strains with reduced penicillin susceptibility. The Spanish 23F -1 clone [profile 4-4-2-4-4-1-1, sequence type (ST) 81] contributes significantly to the emergence of penicillin resistance in Germany (n ¼ 21, 46·7 % of all penicillin non-susceptible serotype 23F isolates). Isolates of ST 277 (profile 7-13-8-6-6-12-8), which has been found previously in the Netherlands, are also observed, particularly in western Germany (n ¼ 8, 17·8 %). A high proportion of strains (n ¼ 11, 24·4 %) have sequence types that have not been reported to date from other countries (STs 353-362). The major penicillin-resistant clones are present in Germany, a country with relatively low levels of â-lactam resistance.
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