Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation.
Rapid point-of-care resistance diagnostics (POC-RD) are a key tool in the fight against antibiotic resistance. By tailoring drug choice to infection genotype, doctors can improve treatment efficacy while limiting costs of inappropriate antibiotic prescription. Here, we combine epidemiological theory...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2019-05-01
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| Series: | PLoS Biology |
| Online Access: | https://doi.org/10.1371/journal.pbio.3000250 |
| _version_ | 1818936402113462272 |
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| author | David McAdams Kristofer Wollein Waldetoft Christine Tedijanto Marc Lipsitch Sam P Brown |
| author_facet | David McAdams Kristofer Wollein Waldetoft Christine Tedijanto Marc Lipsitch Sam P Brown |
| author_sort | David McAdams |
| collection | DOAJ |
| description | Rapid point-of-care resistance diagnostics (POC-RD) are a key tool in the fight against antibiotic resistance. By tailoring drug choice to infection genotype, doctors can improve treatment efficacy while limiting costs of inappropriate antibiotic prescription. Here, we combine epidemiological theory and data to assess the potential of resistance diagnostics (RD) innovations in a public health context, as a means to limit or even reverse selection for antibiotic resistance. POC-RD can be used to impose a nonbiological fitness cost on resistant strains by enabling diagnostic-informed treatment and targeted interventions that reduce resistant strains' opportunities for transmission. We assess this diagnostic-imposed fitness cost in the context of a spectrum of bacterial population biologies and find that POC-RD have a greater potential against obligate pathogens than opportunistic pathogens already subject to selection under "bystander" antibiotic exposure during asymptomatic carriage (e.g., the pneumococcus). We close by generalizing the notion of RD-informed strategies to incorporate carriage surveillance information and illustrate that coupling transmission-control interventions to the discovery of resistant strains in carriage can potentially select against resistance in a broad range of opportunistic pathogens. |
| first_indexed | 2024-12-20T05:35:29Z |
| format | Article |
| id | doaj.art-2bd6ab05abad4b53bb5322485aa4f5d8 |
| institution | Directory Open Access Journal |
| issn | 1544-9173 1545-7885 |
| language | English |
| last_indexed | 2024-12-20T05:35:29Z |
| publishDate | 2019-05-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Biology |
| spelling | doaj.art-2bd6ab05abad4b53bb5322485aa4f5d82022-12-21T19:51:37ZengPublic Library of Science (PLoS)PLoS Biology1544-91731545-78852019-05-01175e300025010.1371/journal.pbio.3000250Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation.David McAdamsKristofer Wollein WaldetoftChristine TedijantoMarc LipsitchSam P BrownRapid point-of-care resistance diagnostics (POC-RD) are a key tool in the fight against antibiotic resistance. By tailoring drug choice to infection genotype, doctors can improve treatment efficacy while limiting costs of inappropriate antibiotic prescription. Here, we combine epidemiological theory and data to assess the potential of resistance diagnostics (RD) innovations in a public health context, as a means to limit or even reverse selection for antibiotic resistance. POC-RD can be used to impose a nonbiological fitness cost on resistant strains by enabling diagnostic-informed treatment and targeted interventions that reduce resistant strains' opportunities for transmission. We assess this diagnostic-imposed fitness cost in the context of a spectrum of bacterial population biologies and find that POC-RD have a greater potential against obligate pathogens than opportunistic pathogens already subject to selection under "bystander" antibiotic exposure during asymptomatic carriage (e.g., the pneumococcus). We close by generalizing the notion of RD-informed strategies to incorporate carriage surveillance information and illustrate that coupling transmission-control interventions to the discovery of resistant strains in carriage can potentially select against resistance in a broad range of opportunistic pathogens.https://doi.org/10.1371/journal.pbio.3000250 |
| spellingShingle | David McAdams Kristofer Wollein Waldetoft Christine Tedijanto Marc Lipsitch Sam P Brown Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation. PLoS Biology |
| title | Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation. |
| title_full | Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation. |
| title_fullStr | Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation. |
| title_full_unstemmed | Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation. |
| title_short | Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation. |
| title_sort | resistance diagnostics as a public health tool to combat antibiotic resistance a model based evaluation |
| url | https://doi.org/10.1371/journal.pbio.3000250 |
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