The evolution of antibiotic resistance in a structured host population
The evolution of antibiotic resistance in a structured host population
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DOI：
10.1098/rsif.2018.0040
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发表时间：
2018-06-01
影响因子：
3.9
通讯作者：
Fraser, Christophe
中科院分区：
文献类型：
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作者：
Blanquart, Francois;Lehtinen, Sonja;Fraser, Christophe
肺炎链球菌、大肠杆菌或金黄色葡萄球菌等机会致病菌抗生素耐药性的演变是一个重大的公共卫生问题，因为耐药菌株的感染导致住院时间延长和死亡风险增加。在这里，我们建立了一个新的共生细菌群体抗生素耐药性进化模型，该群体适应由未经治疗和治疗的宿主组成的异质宿主群体，并在不同的宿主类别中使用不同的抗生素。宿主班的例子包括年龄组和地理位置。明确地对抗生素治疗进行建模表明，更频繁但更短的抗生素疗程和更高的传播率有利于耐药菌株的出现。此外，在一个结构化的宿主群体中，宿主类别中的局部传播既促进了细菌群体的局部适应，也促进了敏感菌株和耐药菌株之间共存的全球维持。当传播率在宿主类别之间存在异质性时，耐药菌株更容易在核心传播群体中进化。这些发现对更好地管理抗生素耐药性具有启示意义：降低个体接受抗生素的比率比缩短治疗时间更有效地减少耐药性。降低宿主人群中某一目标群体的治疗率可以更大程度地降低耐药性，但在实践中很难确定针对哪一类人群。
The evolution of antibiotic resistance in opportunistic pathogens such as Streptococcus pneumoniae, Escherichia coli or Staphylococcus aureus is a major public health problem, as infection with resistant strains leads to prolonged hospital stay and increased risk of death. Here, we develop a new model of the evolution of antibiotic resistance in a commensal bacterial population adapting to a heterogeneous host population composed of untreated and treated hosts, and structured in different host classes with different antibiotic use. Examples of host classes include age groups and geographic locations. Explicitly modelling the antibiotic treatment reveals that the emergence of a resistant strain is favoured by more frequent but shorter antibiotic courses, and by higher transmission rates. In addition, in a structured host population, localized transmission in host classes promotes both local adaptation of the bacterial population and the global maintenance of coexistence between sensitive and resistant strains. When transmission rates are heterogeneous across host classes, resistant strains evolve more readily in core groups of transmission. These findings have implications for the better management of antibiotic resistance: reducing the rate at which individuals receive antibiotics is more effective to reduce resistance than reducing the duration of treatment. Reducing the rate of treatment in a targeted class of the host population allows greater reduction in resistance, but determining which class to target is difficult in practice.