However, 10 strains were not distinguished by the standard method (
quellung reaction) because they reacted with both factors, 6b and 6c.
Serotypes were determined by
Quellung reaction or PCR testing or predicted based on complete multilocus sequence typing, as described in the text.
Pneumococcal serotypes were determined at the Centers for Disease Control and Prevention by the latex agglutination test and confirmed with
Quellung reaction. The presence of mef and/or ermB was determined by using a duplex polymerase chain reaction (PCR) (7), and mefA was differentiated from mefE by PCR-restriction fragment length polymorphisms (8).
All isolates were serotyped by the
quellung reaction (6) with sera of various levels of reactivity from the Statens Seruminstitut (Copenhagen, Denmark).
Serotyping was performed by the
Quellung reaction (Quellung antisera, Staten Seruminstitut, Copenhagen).
Pneumococcal serogrouping was performed with the
Quellung reaction with a standard technique (5) and a diagnostic kit from Statens Serum Institut (SSI), Copenhagen, Denmark.