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>