Why do you think your paper is highly cited?

There had been an earlier paper, published in the late 1980s (Spika et. al.), that had used the same surveillance data to show that very little drug resistance for pneumococci had emerged in the United States despite reports of emergence elsewhere in the world (like in South Africa, south Asia, and Europe). So, our finding a few years later that a fairly high proportion of pneumococci in the U.S. was resistant was sort of a "sounding of alarms" (in fact, I think that term was used around that time quite frequently).

  Can you describe the significance of your work for the field of antibiotic resistance research?

I think that the significance of our work was fairly minor because it didn't take too long before many people were observing the same thing. It did lead to a change in priorities and focus at CDC and in state health departments to surveillance for drug resistance and programs to reduce unnecessary antimicrobial use. Subsequently, there were quite a few activities/research at CDC and other centers of research and at state health departments.

  What were the circumstances that led you to do this research?

We had been collecting pneumococcal isolates from a number of hospitals around the country since the late 1970s, if I remember correctly, to evaluate the impact of 23-valent pneumococcal vaccine. Since we had these isolates, it was possible to bring them out of storage and evaluate them for drug susceptibility.

Robert F. Breiman, M.D.
Programme on Infectious Diseases and Vaccine Sciences
Centre for Health and Population Research
International Centre for Diarrhoeal Disease Research, Bangladesh
Bangladesh