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首页> 外文期刊>Proceedings of the National Academy of Sciences of the United States of America >Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals
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Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals

机译：生态学理论表明，抗菌素循环不会降低医院的抗菌素耐药性

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摘要

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.
机译：由抗生素抗性细菌引起的医院获得性感染对公共卫生构成了严重且日益严重的威胁。在几个月到几年的时间尺度上交替使用两种或两种以上抗生素类别的抗菌循环，似乎是寻找可以减缓抗生素耐药性在医院中发展和传播的治疗策略的主要候选人。我们在医院环境中开发了抗菌素循环的数学模型，并使用该模型来探索循环程序的功效。我们发现骑自行车不太可能减少抗生素耐药性的发展或扩散。替代药物的使用策略，例如混合，可以使每个接受治疗的患者接受医院同时使用的几种药物中的一种，从而更加有效。这些结果以简单的生态学解释为基础。异质抗生素的使用减缓了耐药性的传播。但是，在与细菌种群有关的规模上，混合比循环具有更大的异质性。结果，循环不太可能有效，甚至可能阻碍电阻控制。这些结果可能解释了迄今为止为止抗菌药物循环临床试验报道的有限的成功。

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