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

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dc.contributor.author Bergstrom, Carl T. en_US
dc.contributor.author Lo, Monique en_US
dc.contributor.author Lipsitch, Marc en_US
dc.date.accessioned 2004-10-18T21:03:56Z en_US
dc.date.accessioned 2007-06-13T19:57:43Z
dc.date.available 2004-10-18T21:03:56Z en_US
dc.date.available 2007-06-13T19:57:43Z
dc.date.issued 2004 en_US
dc.identifier.citation Proceedings of the National Academy of Sciences USA. 101:13285-13290 en_US
dc.identifier.uri http://hdl.handle.net/1773/1984 en_US
dc.description.abstract 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. en_US
dc.format.extent 457920 bytes en_US
dc.format.mimetype application/pdf en_US
dc.language.iso en_US en_US
dc.publisher Proceedings of the National Academy of Sciences USA en_US
dc.subject antimicrobial resistance en_US
dc.subject antibiotic cycling en_US
dc.subject nosocomial infection en_US
dc.subject disease ecology en_US
dc.subject hospital en_US
dc.title Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals en_US
dc.type Article en_US


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