Schroeder MR, et al. - This study assessed the impact of heptavalent pneumococcal conjugate vaccine (PCV7) and PCV13 on macrolide-resistant invasive pneumococcal disease (MR-IPD). As per findings, the selective pressures of widespread macrolide use and PCV7 and PCV13 introductions on S. pneumoniae were associated with changes in macrolide resistance and the molecular basis over time in the study population. Durable surveillance and programs that emphasize the judicious use of antibiotics need to continue to be a focus of public health strategies directed at S. pneumoniae.