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Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals [Bulletin]

 
[Une théorie écologique insinue que la rotation des antibiotiques (cycling) ne réduira pas l'antibiorésistance dans les hôpitaux]
BERGSTROM CT ; LO M ; LIPSITCH M PNA
PNA. 2004/09/07; 101(36) : 13285-13290
Summary: Hospital-acquired infections caused by antibiotic-resistant bacteria pose a grave and growing threat to public health. Antimicrobial cycling, in which two or more antibiotic classes are alternated on a time scale of months to years, seems to be a leading candidate in the search for treatment strategies that can slow the evolution and spread of antibiotic resistance in hospitals. We develop a mathematical model of antimicrobial cycling in a hospital setting and use this model to explore the efficacy of cycling programs. We find that cycling is unlikely to reduce either the evolution or the spread of antibiotic resistance. Alternative drug-use strategies such as mixing, in which each treated patient receives one of several drug classes used simultaneously in the hospital, are predicted to be more effective. A simple ecological explanationunderlies these results. Heterogeneous antibiotic use slows the spread of resistance. However, at the scale relevant to bacterial populations, mixing imposes greater heterogeneity than does cycling. As a consequence, cycling is unlikely to be effective and may even hinder resistance control. These results may explain the limited success reported thus far from clinical trials of antimicrobial cycling.(RESUME D'AUTEUR)
Publication
2004/09/07

Pages
13285-13290

Language
Anglais

Number of ref
39

Published in
PNA

ID notice
318924

Location Call number Status Date due Barcode
CCLIN Est
CClin Est
CHU de Nancy - Hôpitaux de Brabois
Rue du Morvan
54511 Vandoeuvre le Nancy Cedex
Tél : 03.83.15.34.73
cclin.est@chu-nancy.fr
http://www.cclin-est.org/
CCLIN Ouest
CClin Ouest
CHU Hôtel Dieu
CS 26419
35064 Rennes Cedex 2
Tél : 02.99.87.35.31
isabelle.girot@chu-rennes.fr
http://www.cclinouest.com/
CCLIN Paris Nord
CClin Paris-Nord
96 rue Didot
75014 Paris
Tél : 01.40.27.42.00  
karin.lebascle@sap.aphp.fr
http://www.cclinparisnord.org/
CCLIN Sud-Est
CClin Sud-Est
Hospices Civils de Lyon
Hôpital Henry Gabriel
20 route de vourles
69230 Saint-Genis-Laval
Tél : 04.78.86.49.50
cclinse@chu-lyon.fr
http://cclin-sudest.chu-lyon.fr/
CCLIN Sud-Ouest
CClin Sud-Ouest
CHU de Bordeaux
Hôpital Pellegrin - Bâtiment Le Tondu
33076 Bordeaux
Tél : 05.56.79.60.58
cclin.so@chu-bordeaux.fr
http://www.cclin-sudouest.com/

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