The impact of different antibiotic regimens on the emergence of antimicrobial-resistant bacteria.
The impact of different antibiotic regimens on the emergence of antimicrobial-resistant bacteria.
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DOI：
10.1371/journal.pone.0004036
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发表时间：
2008
期刊：
影响因子：
3.7
通讯作者：
Ruan, Shigui
中科院分区：
文献类型：
--
作者：
D'Agata, Erika M. C.;Dupont-Rouzeyrol, Myrielle;Magal, Pierre;Olivier, Damien;Ruan, Shigui
抗生素耐药性细菌的出现和持续传播是一个重大的公共卫生威胁。与抗生素敏感细菌引起的感染相比，抗生素耐药细菌引起的感染与显著更高的发病率和死亡率相关。这些细菌的出现和传播是复杂的，需要结合临床研究无法充分解决的许多相互关联的因素。创建了一个模型，该模型结合了导致耐药细菌出现和传播的几个关键因素，包括免疫系统的影响，耐药基因的获得和抗菌剂暴露。该模型确定了限制抗生素耐药菌株出现的关键策略。具体而言，模拟表明，早期开始抗菌治疗和两种抗生素的联合治疗可防止耐药菌的出现，而较短的疗程和抗生素的顺序给药可促进耐药菌株的出现。主要研究结果表明，（i）较短的抗生素治疗时间和早期中断抗生素治疗为耐药菌株提供了优势，（ii）与序贯抗生素治疗相比，两种抗生素联合治疗可预防耐药菌株的出现，（iii）早期开始抗生素治疗是预防耐药菌株出现的最重要因素之一。这些发现为旨在优化抗菌药物治疗感染和预防抗菌药物耐药性出现的策略提供了新的见解。
The emergence and ongoing spread of antimicrobial-resistant bacteria is a major public health threat. Infections caused by antimicrobial-resistant bacteria are associated with substantially higher rates of morbidity and mortality compared to infections caused by antimicrobial-susceptible bacteria. The emergence and spread of these bacteria is complex and requires incorporating numerous interrelated factors which clinical studies cannot adequately address. A model is created which incorporates several key factors contributing to the emergence and spread of resistant bacteria including the effects of the immune system, acquisition of resistance genes and antimicrobial exposure. The model identifies key strategies which would limit the emergence of antimicrobial-resistant bacterial strains. Specifically, the simulations show that early initiation of antimicrobial therapy and combination therapy with two antibiotics prevents the emergence of resistant bacteria, whereas shorter courses of therapy and sequential administration of antibiotics promote the emergence of resistant strains. The principal findings suggest that (i) shorter lengths of antibiotic therapy and early interruption of antibiotic therapy provide an advantage for the resistant strains, (ii) combination therapy with two antibiotics prevents the emergence of resistance strains in contrast to sequential antibiotic therapy, and (iii) early initiation of antibiotics is among the most important factors preventing the emergence of resistant strains. These findings provide new insights into strategies aimed at optimizing the administration of antimicrobials for the treatment of infections and the prevention of the emergence of antimicrobial resistance.
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DOI：
10.1098/rstb.1999.0425
发表时间：
1999-04-29
影响因子：
6.3
作者：
Austin, DJ;Anderson, RM
通讯作者：
Anderson, RM
影响因子：
2.1
作者：
Bahl, ML;Sorensen, SJ;Hansen, LH
通讯作者：
Hansen, LH
影响因子：
11.8
作者：
Bonten, MJM;Austin, DJ;Lipsitch, M
通讯作者：
Lipsitch, M
影响因子：
3.1
作者：
FRETER, R;BRICKNER, H;CAREY, KE
通讯作者：
CAREY, KE
影响因子：
2.6
作者：
Haneda, T;Okada, N;Danbara, H
通讯作者：
Danbara, H