Estimating the proportion of bystander selection for antibiotic resistance in the US
Estimating the proportion of bystander selection for antibiotic resistance in the US
复制标题
估计美国抗生素耐药性旁观者选择的比例
DOI：
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
M. Lipsitch
中科院分区：
文献类型：
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作者：
C. Tedijanto;S. Olesen;Y. Grad;M. Lipsitch
旁观者选择-抗生素对不是治疗目标病原体的微生物植物群施加的选择压力-对于理解广谱抗生素使用的总体影响至关重要;然而，据我们所知，这种影响从未被量化。使用2010-2011年全国门诊医疗服务调查和全国医院门诊医疗服务调查（NAMCS/NHAMCS），人类微生物组计划，以及来自现有文献的其他携带和病原学数据，我们估计了一系列临床相关抗生素的旁观者选择的程度，种属对是指一个种属在该种属不是致病病原体的条件下经历的抗生素所有暴露的比例（“旁观者暴露比例”）。对于美国的门诊处方，我们发现9种感兴趣的微生物中有8种的这一比例超过所有抗生素的80%。低比例的旁观者暴露通常与罕见的细菌携带或高比例的抗生素处方相关，这些抗生素处方集中于由感兴趣的种属引起的病症。利用旁观者暴露的比例，我们粗略估计S。aureus和E.尽管大肠杆菌不是疫苗针对的病原体，但由于肺炎球菌结合物疫苗接种，估计抗生素使用量减少了90.7%和99.7%，大肠杆菌可能分别受益。这些结果强调了在衡量抗生素耐药性干预措施的影响时，除了目标病原体外，还应考虑旁观者的抗生素暴露。重要性声明导致抗生素耐药人群患病率变化的因素尚未得到充分理解。旁观者选择--抗生素对除治疗靶向病原体以外的微生物植物群无意中施加的压力--被假设为抗生素耐药性传播的主要因素，但其程度尚未得到表征。我们估计了一系列抗生素和生物体中旁观者暴露的比例，并描述了导致这些比例变异的因素。抗生素耐药性干预措施（包括疫苗接种）的影响估计通常仅限于对目标病原体的影响。然而，减少对目标病原体引起的疾病的抗生素治疗可能具有更广泛的潜力，以减少许多其他生物体的抗性的旁观者选择压力。
Bystander selection -- the selective pressures exerted by antibiotics on microbial flora that are not the target pathogen of treatment -- is critical to understanding the total impact of broad-spectrum antibiotic use; however, to our knowledge, this effect has never been quantified. Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS), the Human Microbiome Project, and additional carriage and etiological data from existing literature, we estimate the magnitude of bystander selection for a range of clinically relevant antibiotic-species pairs as the proportion of all exposures of an antibiotic experienced by a species for conditions in which that species was not the causative pathogen (“proportion of bystander exposures”). For outpatient prescribing in the United States, we find that this proportion over all included antibiotics is over 80% for 8 out of 9 organisms of interest. Low proportions of bystander exposure are often associated with infrequent bacterial carriage or a high proportion of antibiotic prescribing focused on conditions caused by the species of interest. Using the proportion of bystander exposures, we roughly estimate that S. aureus and E. coli may benefit from 90.7% and 99.7%, respectively, of the estimated reduction in antibiotic use due to pneumococcal conjugate vaccination, despite not being the pathogen targeted by the vaccine. These results underscore the importance of considering antibiotic exposures to bystanders, in addition to the targeted pathogen, in measuring the impact of antibiotic resistance interventions. Significance Statement The forces that contribute to changing population prevalence of antibiotic resistance are not well understood. Bystander selection -- the inadvertent pressures imposed by antibiotics on the microbial flora other than the pathogen targeted by treatment -- is hypothesized to be a major factor in the propagation of antibiotic resistance, but its extent has not been characterized. We estimate the proportion of bystander exposures across a range of antibiotics and organisms and describe factors driving variability of these proportions. Impact estimates for antibiotic resistance interventions, including vaccination, are often limited to effects on a target pathogen. However, the reduction of antibiotic treatment for illnesses caused by the target pathogen may have the broader potential to decrease bystander selection pressures for resistance on many other organisms.
影响因子：
120.7
作者：
Gupta, K;Scholes, U;Stamm, WE
通讯作者：
Stamm, WE
影响因子：
6.6
作者：
Edlin, Rachel S.;Shapiro, Daniel J.;Hersh, Adam L.;Copp, Hillary L.
通讯作者：
Copp, Hillary L.