Streptococcus pneumoniae is among the most common pathogens associated with chronic otitis media with effusion, which has been hypothesized to be a biofilm disease. S. pneumoniae has been shown to form biofilms, however, little is known about the developmental process, the architecture, and the changes that occur upon biofilm development. In the current study we made use of a continuous-culture biofilm system to characterize biofilm development of 14 different S. pneumoniae strains representing at least 10 unique serotypes. The biofilm development process was found to occur in three distinct stages, including initial attachment, cluster formation, and biofilm maturation. While all 14 pneumococcal strains displayed similar developmental stages, the mature biofilm architecture differed significantly among the serotypes tested. Overall, three biofilm architectural groups were detected based on biomass, biofilm thickness, and cluster size. The biofilm viable cell counts and total protein concentration increased steadily over the course of biofilm development, reaching ϳ8 ؋ 10 8 cells and ϳ15 mg of protein per biofilm after 9 days of biofilm growth. Proteomic analysis confirmed the presence of distinct biofilm developmental stages by the detection of multiple phenotypes over the course of biofilm development. The biofilm development process was found to correlate not only with differential production of proteins but also with a dramatic increase in the number of detectable proteins, indicating that biofilm formation by S. pneumoniae may be a far more complex process than previously anticipated. Protein identification revealed that proteins involved in virulence, adhesion, and resistance were more abundant under biofilm growth conditions. A possible role of the identified proteins in biofilm formation is discussed.Streptococcus pneumoniae is an important human pathogen that causes an array of diseases, including acute bacterial sinusitis, meningitis, and bacteremia, and remains the major cause of acute bacterial pneumonia and otitis media. Worldwide, approximately 1.1 million deaths annually are attributed to S. pneumoniae infection (42). S. pneumoniae is among the most common microorganisms isolated from otitis media specimens, others including Haemophilus influenzae, Moraxella catarrhalis, and Alliococcus otiditis (30). The gram-positive, opportunistic pathogen S. pneumoniae has been cultured from approximately 40% of middle-ear fluid samples taken from patients with acute otitis media (9, 24).Next to the common cold, otitis media is the most commonly diagnosed childhood illness in the United States. Otitis media is a clinical diagnosis and the most prevalent infectious disease in children, characterized by the accumulation of fluid in the middle-ear space. Approximately one-third of all children experience three or more episodes of acute otitis media by the age of 3 years (27). Conductive hearing loss is a major consequence of otitis media that may affect the child's behavior, education, or development of language ...