Analysis of multiple bacterial species and antibiotic classes reveals large variation in the association between seasonal antibiotic use and resistance.
Analysis of multiple bacterial species and antibiotic classes reveals large variation in the association between seasonal antibiotic use and resistance.
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DOI：
10.1371/journal.pbio.3001579
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发表时间：
2022-03
期刊：
影响因子：
9.8
通讯作者：
Grad YH
中科院分区：
文献类型：
--
作者：
Sun DS;Kissler SM;Kanjilal S;Olesen SW;Lipsitch M;Grad YH
了解抗生素的使用如何驱动耐药性对于指导限制耐药性传播的有效策略至关重要，但病原体和抗生素之间的使用-耐药性关系仍不清楚。我们应用正弦模型评价了马萨诸塞州波士顿3个菌种（金黄色葡萄球菌、大肠埃希菌和肺炎克雷伯菌）和5个抗生素类别（青霉素类、大环内酯类、喹诺酮类、四环素类和硝基呋喃类）的季节性使用-耐药性关系。所有5类抗生素的门诊使用以及15种抗生素组合中9种抗生素的住院和门诊分离株的耐药性显示出统计学显著的季节性幅度（错误发现率（FDR）< 0.05）。虽然使用的季节性高峰因类别而异，但所有9种抗生素组合的耐药性都在冬季和春季达到高峰。因此，季节性使用和耐药性之间的相关性差异很大，对所有抗生素类的耐药性与冬季高峰类（青霉素类和大环内酯类）的使用呈正相关。这些发现挑战了抗生素使用独立选择耐药性的简单模型，并表明管理策略不会在所有物种和抗生素中同样有效。相反，对多种抗生素类耐药性的季节性选择可能主要是使用最常用的抗生素类，青霉素和大环内酯类。在马萨诸塞州波士顿进行的一项关于抗生素使用与耐药性之间关系的研究表明，多种病原体的抗生素耐药性在冬季/春季达到高峰，与青霉素类和大环内酯类的使用最相关--冬季使用高峰的抗生素。
Understanding how antibiotic use drives resistance is crucial for guiding effective strategies to limit the spread of resistance, but the use–resistance relationship across pathogens and antibiotics remains unclear. We applied sinusoidal models to evaluate the seasonal use–resistance relationship across 3 species (Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae) and 5 antibiotic classes (penicillins, macrolides, quinolones, tetracyclines, and nitrofurans) in Boston, Massachusetts. Outpatient use of all 5 classes and resistance in inpatient and outpatient isolates in 9 of 15 species–antibiotic combinations showed statistically significant amplitudes of seasonality (false discovery rate (FDR) < 0.05). While seasonal peaks in use varied by class, resistance in all 9 species–antibiotic combinations peaked in the winter and spring. The correlations between seasonal use and resistance thus varied widely, with resistance to all antibiotic classes being most positively correlated with use of the winter peaking classes (penicillins and macrolides). These findings challenge the simple model of antibiotic use independently selecting for resistance and suggest that stewardship strategies will not be equally effective across all species and antibiotics. Rather, seasonal selection for resistance across multiple antibiotic classes may be dominated by use of the most highly prescribed antibiotic classes, penicillins and macrolides. A study of the relationship between antibiotic use and resistance in Boston, Massachusetts shows that antibiotic resistance in multiple pathogens peaks in the winter/spring and is most correlated with the use of penicillins and macrolides – the antibiotics with winter-peaking use.
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