Disease transmission dynamics and the evolution of antibiotic resistance in hospitals and communal settings

Despite the tremendous benefits of antibiotics for dealing with a wide range of pathogens, there is by now little doubt that their indiscriminate use has led to the emergence of novel resistant strains and a frightening new set of threats to public health. Hospitals and other community settings provide an especially fertile ground for the spread of those types; in particular, the recent emergence and proliferation of bacteria resistant to both methicillin and vancomycin has engendered serious concern, threatening the effectiveness of the last available options for treatment of potentially fatal Staphylococcus strains.

It seems clear that a considered and comprehensive strategy for antibiotic use is essential, permitting the intelligent deployment of antibiotics at rates that will not outpace our ability to develop new alternatives. Such a strategy should be built upon a quantitative theoretical foundation, derived from a firm understanding of how communal use of antibiotics translates into the emergence of resistant strains. Were such a theory available, one could base upon it a management strategy that would balance health costs and benefits in a way to make antibiotics available to those who most need them, without undercutting the long term community effectiveness of those drugs. Unfortunately, no such theory yet exists; but in this issue of the Proceedings Austin, Kristinsson, and Anderson (1) provide the framework for developing one. Their work, complemented by that of investigators such as B. Levin, Stewart, and others (2–6) provides the first such effort and a hopeful point of departure for future work. In this note, we summarize the main insights derived by Austin et al. (1) and indicate some further directions for investigations.