We did not identify any Spn isolates that were resistant to penicillin at the non-meningitis breakpoint; however, more than half of isolates were resistant to penicillin at the meningitis breakpoint (n = 152, 58%), including over 90% of isolates identified as serotypes 19A, 19F, and 35B (S2 Table, Fig 2). This evidence concerns the gene SPN and infectious meningitis.