Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens
- Harvard TH Chan School of Public Health, United States
Abstract
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.
Data availability
Data from the 2015 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) are publicly available from the National Center for Health Statistics. This study also uses data from published literature, including the Human Microbiome Project and other studies summarized in Figure 1 - Source Data File 1.
Article and author information
Author details
Christine Tedijanto
Funding
National Institute of General Medical Sciences (U54GM088558)
- Marc Lipsitch
National Institute of Allergy and Infectious Diseases (R01AI132606)
- Yonatan H Grad
Centers for Disease Control and Prevention (CK000538-01)
- Marc Lipsitch
Doris Duke Charitable Foundation
- Yonatan H Grad
National Institute of Allergy and Infectious Diseases (T32AI007535)
- Christine Tedijanto
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Copyright
© 2020, Tedijanto et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens
eLife 9:e52307.
https://doi.org/10.7554/eLife.52307
