Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens

eLife

Marc Lipsitch¹  Christine Tedijanto²  Yonatan H Grad³ 

[1] Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, United States;Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States;Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States;

关键词: resistance;    stewardship;    antibiotics;    outpatient;   

DOI  :  10.7554/eLife.52307

来源: DOAJ

【 摘 要 】

The relationship between antibiotic stewardship and population levels of antibiotic resistance remains unclear. In order to better understand shifts in selective pressure due to stewardship, we use publicly available data to estimate the effect of changes in prescribing on exposures to frequently used antibiotics experienced by potentially pathogenic bacteria that are asymptomatically colonizing the microbiome. We quantify this impact under four hypothetical stewardship strategies. In one scenario, we estimate that elimination of all unnecessary outpatient antibiotic use could avert 6% to 48% (IQR: 17% to 31%) of exposures across pairwise combinations of sixteen common antibiotics and nine bacterial pathogens. All scenarios demonstrate that stewardship interventions, facilitated by changes in clinician behavior and improved diagnostics, have the opportunity to broadly reduce antibiotic exposures across a range of potential pathogens. Concurrent approaches, such as vaccines aiming to reduce infection incidence, are needed to further decrease exposures occurring in ‘necessary’ contexts.

【 授权许可】

Unknown