The distribution of antibiotic use and its association with antibiotic resistance
The distribution of antibiotic use and its association with antibiotic resistance
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DOI：
10.7554/elife.39435
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发表时间：
2018-12-18
期刊：
影响因子：
7.7
通讯作者：
Grad, Yonatan H.
中科院分区：
文献类型：
--
作者：
Olesen, Scott W.;Barnett, Michael L.;Grad, Yonatan H.
抗生素的使用是抗生素耐药性的主要驱动因素。然而，抗生素的使用可以在人群中以不同的方式分布，并且使用分布与抗生素耐药性之间的关系尚未探讨。在这里，我们检验了重复使用抗生素与广泛分布、低强度使用抗生素相比与人群抗生素耐药性有更强关联的假设。首先，我们描述了美国各州门诊抗生素使用的分布，发现抗生素使用不均匀，重复使用抗生素占抗生素使用的少数。其次，我们比较了各州72种病原体-抗生素组合的抗生素使用与耐药性。最后，将总使用量划分为粗放边际和集约边际，我们发现，与粗放边际相比，密集边际与抗性的关联较弱。如果使用-阻力关系是因果关系，这些结果表明，减少总使用和选择强度将需要减少广泛分布的低强度使用。
Antibiotic use is a primary driver of antibiotic resistance. However, antibiotic use can be distributed in different ways in a population, and the association between the distribution of use and antibiotic resistance has not been explored. Here, we tested the hypothesis that repeated use of antibiotics has a stronger association with population-wide antibiotic resistance than broadly-distributed, low-intensity use. First, we characterized the distribution of outpatient antibiotic use across US states, finding that antibiotic use is uneven and that repeated use of antibiotics makes up a minority of antibiotic use. Second, we compared antibiotic use with resistance for 72 pathogen-antibiotic combinations across states. Finally, having partitioned total use into extensive and intensive margins, we found that intense use had a weaker association with resistance than extensive use. If the use-resistance relationship is causal, these results suggest that reducing total use and selection intensity will require reducing broadly distributed, low-intensity use.