Resistance diagnostics as a public health tool to combat antibiotic resistance: A model-based evaluation.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • McAdams, D; Wollein Waldetoft, K; Tedijanto, C; Lipsitch, M; Brown, SP

Published Date

  • May 2019

Published In

Volume / Issue

  • 17 / 5

Start / End Page

  • e3000250 -

PubMed ID

  • 31095567

Pubmed Central ID

  • PMC6522007

Electronic International Standard Serial Number (EISSN)

  • 1545-7885

International Standard Serial Number (ISSN)

  • 1544-9173

Digital Object Identifier (DOI)

  • 10.1371/journal.pbio.3000250


  • eng