Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens
The relationship between antibiotic stewardship and population levels of antibiotic resistance remains unclear. In order to better understand shifts in selective pressure due to stewardship, we use publicly available data to estimate the effect of changes in prescribing on exposures to frequently us...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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eLife Sciences Publications Ltd
2020-02-01
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| Series: | eLife |
| Subjects: | |
| Online Access: | https://elifesciences.org/articles/52307 |
| _version_ | 1811235996484763648 |
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| author | Christine Tedijanto Yonatan H Grad Marc Lipsitch |
| author_facet | Christine Tedijanto Yonatan H Grad Marc Lipsitch |
| author_sort | Christine Tedijanto |
| collection | DOAJ |
| description | The relationship between antibiotic stewardship and population levels of antibiotic resistance remains unclear. In order to better understand shifts in selective pressure due to stewardship, we use publicly available data to estimate the effect of changes in prescribing on exposures to frequently used antibiotics experienced by potentially pathogenic bacteria that are asymptomatically colonizing the microbiome. We quantify this impact under four hypothetical stewardship strategies. In one scenario, we estimate that elimination of all unnecessary outpatient antibiotic use could avert 6% to 48% (IQR: 17% to 31%) of exposures across pairwise combinations of sixteen common antibiotics and nine bacterial pathogens. All scenarios demonstrate that stewardship interventions, facilitated by changes in clinician behavior and improved diagnostics, have the opportunity to broadly reduce antibiotic exposures across a range of potential pathogens. Concurrent approaches, such as vaccines aiming to reduce infection incidence, are needed to further decrease exposures occurring in ‘necessary’ contexts. |
| first_indexed | 2024-04-12T12:01:43Z |
| format | Article |
| id | doaj.art-bfcb261a576a480aab7cfa8401c556a7 |
| institution | Directory Open Access Journal |
| issn | 2050-084X |
| language | English |
| last_indexed | 2024-04-12T12:01:43Z |
| publishDate | 2020-02-01 |
| publisher | eLife Sciences Publications Ltd |
| record_format | Article |
| series | eLife |
| spelling | doaj.art-bfcb261a576a480aab7cfa8401c556a72022-12-22T03:33:50ZengeLife Sciences Publications LtdeLife2050-084X2020-02-01910.7554/eLife.52307Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogensChristine Tedijanto0https://orcid.org/0000-0003-3403-5765Yonatan H Grad1https://orcid.org/0000-0001-5646-1314Marc Lipsitch2https://orcid.org/0000-0003-1504-9213Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United StatesDepartment of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States; Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, United StatesCenter for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United StatesThe relationship between antibiotic stewardship and population levels of antibiotic resistance remains unclear. In order to better understand shifts in selective pressure due to stewardship, we use publicly available data to estimate the effect of changes in prescribing on exposures to frequently used antibiotics experienced by potentially pathogenic bacteria that are asymptomatically colonizing the microbiome. We quantify this impact under four hypothetical stewardship strategies. In one scenario, we estimate that elimination of all unnecessary outpatient antibiotic use could avert 6% to 48% (IQR: 17% to 31%) of exposures across pairwise combinations of sixteen common antibiotics and nine bacterial pathogens. All scenarios demonstrate that stewardship interventions, facilitated by changes in clinician behavior and improved diagnostics, have the opportunity to broadly reduce antibiotic exposures across a range of potential pathogens. Concurrent approaches, such as vaccines aiming to reduce infection incidence, are needed to further decrease exposures occurring in ‘necessary’ contexts.https://elifesciences.org/articles/52307resistancestewardshipantibioticsoutpatient |
| spellingShingle | Christine Tedijanto Yonatan H Grad Marc Lipsitch Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens eLife resistance stewardship antibiotics outpatient |
| title | Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens |
| title_full | Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens |
| title_fullStr | Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens |
| title_full_unstemmed | Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens |
| title_short | Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens |
| title_sort | potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens |
| topic | resistance stewardship antibiotics outpatient |
| url | https://elifesciences.org/articles/52307 |
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