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Vanderkooi OG, Low DE, Green K, Powis JE, McGeer A; Toronto Invasive Bacterial Disease Network. Predicting antimicrobial resistance in invasive pneumococcal infections. Clin Infect Dis. 2005;40:1288-1297. This is a report from the Toronto Invasive Bacterial Disease Network, a prospective cohort study of patients with invasive pneumococcal infections. The results are restricted to invasive pneumococcal infections defined as patients with positive cultures for Streptococcus pneumoniae from normally sterile sites, primarily blood. The analysis included 3339 patients hospitalized between 1995 and 2002. During the course of the study, there was a significant increase in resistance to penicillin, ceftriaxone, erythromycin, and levofloxacin. Thus, one of the most important factors correlating with resistance was the year of infection. These data are shown in Table 1 .
For practical purposes, the most important observation was the strong association between antibiotic administration within 3 months for 3 drugs: penicillin, cotrimoxazole, and azithromycin. These data are provided in Table 2 , with the odds ratio for the risk.
The investigators concluded that knowledge of antibiotic use during the 3 months before the infection was critical for defining the probability of resistance and selecting appropriate therapy.
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