This commentary explains the reasons for the extensive variations in pneumococcal penicillin resistance based on a literature review of pneumococcal penicillin-binding proteins, the pharmacodynamics and pharmacokinetics of beta-lactams, the risk factors associated with mortality, laboratory issues and challenges, including identification, susceptibility testing, and clinical reporting, and the management of invasive and noninvasive Streptococcus pneumoniae infections.
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