Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals
Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals
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DOI：
10.1073/pnas.0402298101
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发表时间：
2004-09-07
影响因子：
11.1
通讯作者：
Lipsitch, M
中科院分区：
文献类型：
--
作者：
Bergstrom, CT;Lo, M;Lipsitch, M
由耐药性细菌引起的医院获得性感染对公共卫生构成严重和日益严重的威胁。抗生素循环，其中两种或多种抗生素类别在数月至数年的时间尺度上交替使用，似乎是寻找治疗策略的主要候选者，可以减缓医院抗生素耐药性的演变和传播。我们开发了一个数学模型的抗菌循环在医院设置，并使用该模型来探索循环程序的有效性。我们发现，循环不太可能减少抗生素耐药性的进化或传播。替代药物使用策略，如混合，其中每个接受治疗的患者接受同时在医院使用的几种药物类别之一，预计将更有效。一个简单的生态学解释是这些结果的基础。异质性抗生素的使用减缓了耐药性的传播。然而，在与细菌种群相关的尺度上，混合比循环施加更大的异质性。因此，骑自行车不太可能是有效的，甚至可能阻碍阻力控制。这些结果可能解释了迄今为止抗菌循环临床试验报告的有限成功。
Hospital-acquired infections caused by antibiotic-resistant bacteria pose a grave and growing threat to public health. Antimicrobial cycling, in which two or more antibiotic classes are alternated on a time scale of months to years, seems to be a leading candidate in the search for treatment strategies that can slow the evolution and spread of antibiotic resistance in hospitals. We develop a mathematical model of antimicrobial cycling in a hospital setting and use this model to explore the efficacy of cycling programs. We find that cycling is unlikely to reduce either the evolution or the spread of antibiotic resistance. Alternative drug-use strategies such as mixing, in which each treated patient receives one of several drug classes used simultaneously in the hospital, are predicted to be more effective. A simple ecological explanation underlies these results. Heterogeneous antibiotic use slows the spread of resistance. However, at the scale relevant to bacterial populations, mixing imposes greater heterogeneity than does cycling. As a consequence, cycling is unlikely to be effective and may even hinder resistance control. These results may explain the limited success reported thus far from clinical trials of antimicrobial cycling.