01resistance - SUPPLEMENT ARTICLE Minimizing Potential...

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Population Dynamics of Resistance CID 2001:33 (Suppl 3) S161 SUPPLEMENT ARTICLE Minimizing Potential Resistance: A Population Dynamics View Bruce R. Levin Department of Biology, Emory University, Atlanta I examine the results of studies that used mathematical models of the epidemiology and population genetics of antibiotic treatment and resistance in open communities and in hospitals to explore the following issues: the relationship between antibiotic consumption and the frequency of antibiotic resistance in bacterial pop- ulations in communities and in hospitals; methods of controlling the growth, dissemination, and persistence of antibiotic resistance in these settings; the extent to which resistance can be controlled; and the speed with which the effects of control measures will be realized. In open communities, it will take years or even decades to see substantial reductions in the frequency of antibiotic resistance solely as a result of more prudent (reduced) use of antibiotics. However, if we can restrict the input of resistant bacteria into hospitals, through the application of infection control and other measures, it should be possible to reduce the frequency of resistance and even eliminate resistant bacteria from these institutions in short order. It is clear that the widespread evolution, dispersal, and maintenance of genes and accessory elements coding for resistance to antibiotics in the pathogenic and com- mensal bacteria of humans and domestic animals can be attributed to the use of these agents for treatment and prophylaxis in humans and for growth promotion in livestock. It is also clear that the frequency of resis- tance in bacteria and the number of different antibiotics to which individual bacteria are resistant are directly related to the consumption of these agents and the patterns in which different agents are used [1–6]. Not so clear is whether we can substantially reduce the fre- quency of antibiotic resistance in bacteria by controlling the consumption of antibiotics and modifying the pat- terns of use of different antibiotics. Also not clear is how much time it will take before the effects of these interventions will be realized. In this report, I explore the problem of controlling Reprints or correspondence: Dr. Bruce R. Levin, Dept. of Biology, Emory University, 1510 Clifton Rd., Atlanta, GA 30322 ([email protected]). Clinical Infectious Diseases 2001;33(Suppl 3):S161–9 Q 2001 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2001/3306S3-0011$03.00 antibiotic resistance from the perspective of population biology. I separately consider what mathematical mod- els of the epidemiology of drug resistance tell us about the factors contributing to the ascent of resistance in open communities and in the closed settings of hos- pitals and nursing homes. Based on the results of the analysis of these models, some data, and some preju- dices about human behavior and social systems, I argue that it is unlikely that in countries such as the United
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01resistance - SUPPLEMENT ARTICLE Minimizing Potential...

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