10.1371/journal.pbio.3000250
David McAdams
David
McAdams
Kristofer Wollein Waldetoft
Kristofer Wollein
Waldetoft
Christine Tedijanto
Christine
Tedijanto
Marc Lipsitch
Marc
Lipsitch
Sam P. Brown
Sam
P. Brown
Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation
Public Library of Science
2019
POC-RD
nonbiological fitness cost
strain
model-based evaluation Rapid point-of-care resistance diagnostics
RD
diagnostic-imposed fitness cost
pathogen
combat antibiotic resistance
antibiotic resistance
resistance diagnostics
carriage surveillance information
2019-05-16 17:26:50
Dataset
https://plos.figshare.com/articles/dataset/Resistance_diagnostics_as_a_public_health_tool_to_combat_antibiotic_resistance_A_model-based_evaluation/8139656
<div><p>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.</p></div>