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Introduction: Streptococcus pneumoniae is the main bacterial cause of pneumonia, bacteremia and meningitis. Incidence rates have decreased since the initiation of pneumococcal vaccines, but antibiotic resistant strains continue to emerge and place a heavy burden on healthcare systems to treat such serious resistant infections. This study looks at risk factors that increase a patients probability of contracting a drug resistant strain of S. pneumo. Methods: Confirmed cases of S. pneumo were acquired through the Active Bacterial Core Surveillance program from 2009-2012 for the state of Georgia. Cumulative incidence rates, odds ratios and Pearson’s chi square were calculated to test for trends. Multi-logistic regression model was designed to control for covariates. Antibiotic Susceptibility results were analyzed by resistant profiles through WHONET. Results: Cumulative incidence rates have decreased significantly, however antibiotic resistant and multidrug resistant strains have increased. Incidence rates for children less than five and adults over 65 have decreased, however, the burden of disease remains in young to middle adults. Antibiotic resistant strains have shifted from penicillin to erythromycin and cefotaxime. Discussion: Interventions need to be targeted towards young to middle aged adults. Antibiotic stewardship programs should seek uniform guidelines to battle the increasing emergence of multidrug resistant strains.