Antibiotic-Resistant Neisseria gonorrhoeae Spread Faster with More Treatment, Not More Sexual Partners.
Antibiotic-Resistant Neisseria gonorrhoeae Spread Faster with More Treatment, Not More Sexual Partners.
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DOI：
10.1371/journal.ppat.1005611
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发表时间：
2016-05
期刊：
影响因子：
6.7
通讯作者：
Althaus CL
中科院分区：
文献类型：
--
作者：
Fingerhuth SM;Bonhoeffer S;Low N;Althaus CL
性传播细菌淋球菌对所有用于治疗的抗生素类别都产生了抗药性，并对多种抗生素类别产生了抗药性。在许多国家，淋球菌的经验性治疗只剩下一种抗生素，迫切需要对抗生素进行管理，以对抗耐药性的传播。了解耐药性传播的动态和驱动因素可以为抗生素管理提供更好的理论基础。在我们的研究中，我们首先使用抗生素耐药性监测数据来估计抗生素耐药性淋病奈瑟菌在两个宿主人群中的传播率，即异性恋男性(HetM)和男男性行为者(MSM)。我们发现MSM的扩散率(0.86年至2.38y−1，平均倍增时间：6个月)高于HetM(0.24至0.86年−1，平均倍增时间：16个月)。然后，我们开发了一个动态传播模型，以再现观察到的淋球菌在异性恋男女(HMW)和男男性接触者(MSM)人群中的传播动态。我们使用性行为数据对模型进行了参数化，并将其与淋病奈瑟菌的流行和发病率数据进行了校准。在该模型中，耐药淋球菌在HMW和MSM中的传播速度中位数分别为0.88y−1和3.12y−1。这些比率相当于9个月(HMW)和3个月(MSM)的中位数倍增时间。假设没有健身成本，该模型显示了宿主人群治疗率的差异，而不是性伴侣数量的差异，这解释了耐药性传播的差异。由于更高的治疗率会导致抗生素耐药性更快的传播，因此对淋病奈瑟菌的治疗建议应该谨慎地平衡预防感染和避免耐药性传播。越来越多的传染病治疗失败，因为致病病原体对用于治疗的药物具有抗药性。对于淋球菌这种性传播细菌的治疗，耐药性是一个特别大的问题：推荐治疗的抗生素只剩下一种。我们的目标是了解耐药淋球菌是如何在性活跃的宿主群体中传播的，以及如何减缓耐药性的传播。根据抗生素耐药性监测数据，我们首先估计了耐药淋病奈瑟菌的传播速度。其次，我们在描述主机之间传播的数学模型中复制了观察到的动力学。我们发现，与异性恋人群相比，耐药淋病奈瑟菌在男男性行为者的宿主人群中传播得更快。我们可以将耐药病原体更快的传播归因于更高的治疗率。这一发现表明，促进筛查以控制耐药淋病奈瑟菌实际上可以加速它们的传播。
The sexually transmitted bacterium Neisseria gonorrhoeae has developed resistance to all antibiotic classes that have been used for treatment and strains resistant to multiple antibiotic classes have evolved. In many countries, there is only one antibiotic remaining for empirical N. gonorrhoeae treatment, and antibiotic management to counteract resistance spread is urgently needed. Understanding dynamics and drivers of resistance spread can provide an improved rationale for antibiotic management. In our study, we first used antibiotic resistance surveillance data to estimate the rates at which antibiotic-resistant N. gonorrhoeae spread in two host populations, heterosexual men (HetM) and men who have sex with men (MSM). We found higher rates of spread for MSM (0.86 to 2.38 y−1, mean doubling time: 6 months) compared to HetM (0.24 to 0.86 y−1, mean doubling time: 16 months). We then developed a dynamic transmission model to reproduce the observed dynamics of N. gonorrhoeae transmission in populations of heterosexual men and women (HMW) and MSM. We parameterized the model using sexual behavior data and calibrated it to N. gonorrhoeae prevalence and incidence data. In the model, antibiotic-resistant N. gonorrhoeae spread with a median rate of 0.88 y−1 in HMW and 3.12 y−1 in MSM. These rates correspond to median doubling times of 9 (HMW) and 3 (MSM) months. Assuming no fitness costs, the model shows the difference in the host population’s treatment rate rather than the difference in the number of sexual partners explains the differential spread of resistance. As higher treatment rates result in faster spread of antibiotic resistance, treatment recommendations for N. gonorrhoeae should carefully balance prevention of infection and avoidance of resistance spread. More and more infectious disease treatments fail because the causative pathogens are resistant to the drugs used for treatment. For the treatment of Neisseria gonorrhoeae, a sexually transmitted bacterium, drug resistance is a particularly big problem: there is only a single antibiotic left that is recommended for treatment. We aimed to understand how antibiotic-resistant N. gonorrhoeae spread in a sexually active host population and how the spread of resistance can be slowed. From antibiotic resistance surveillance data, we first estimated the rate at which antibiotic-resistant N. gonorrhoeae spread. Second, we reproduced the observed dynamics in a mathematical model describing the transmission between hosts. We found that antibiotic-resistant N. gonorrhoeae spread faster in host populations of men who have sex with men than in host populations of heterosexuals. We could attribute the faster spread of resistant pathogens to higher treatment rates. This finding implies that promoting screening to control antibiotic-resistant N. gonorrhoeae could in fact accelerate their spread.