The body is home to a diverse microbiota, mainly in the gut. Resistant bacteria are selected for by antibiotic treatments, and once resistance becomes widespread in a population of hosts, antibiotics become useless. Here, we develop a multiscale model of the interaction between antibiotic use and resistance spread in a host population, focusing on an important aspect of within-host immunity. Antibodies secreted in the gut enchain bacteria upon division, yielding clonal clusters of bacteria. We demonstrate that immunity-driven bacteria clustering can hinder the spread of a novel resistant bacterial strain in a host population. We quantify this effect both in the case where resistance pre-exists and in the case where acquiring a new resistance mutation is necessary for the bacteria to spread. We further show that the reduction of spread by clustering can be countered when immune hosts are silent carriers, and are less likely to get treated, and/or have more contacts. We demonstrate the robustness of our findings to including stochastic within-host bacterial growth, a fitness cost of resistance, and its compensation. Our results highlight the importance of interactions between immunity and the spread of antibiotic resistance, and argue in the favor of vaccine-based strategies to combat antibiotic resistance.
Bacterial resistance to antibiotic treatment is a huge concern: introduction of any new antibiotic is shortly followed by the emergence of resistant bacterial isolates in the clinic. This issue is compounded by a severe lack of new antibiotics reaching the market. The significant rise in clinical resistance to antibiotics is especially problematic in nosocomial infections, where already vulnerable patients may fail to respond to treatment, causing even greater health concern. A recent focus has been on the development of anti-virulence drugs as a second line of defence in the treatment of anti…
The large reservoir of antibiotic resistant bacteria in raw and treated water supplies is a matter of public health concern. Currently, the National Antimicrobial Resistance Monitoring Systems, a collaborative effort of the Centers for Disease Control, the US Department of Agriculture, and the US Food and Drug Administration, does not monitor antimicrobial resistance in surface waters. Given the serious nature of antibiotic resistance in clinical settings, and the likelihood that antibiotic resistant bacteria can be transmitted to humans from large environmental reservoirs via drinking water, …
As antibiotic resistance grows more frequent for common bacterial infections, alternative treatment strategies such as phage therapy have become more widely studied in the medical field. While many studies have explored the efficacy of antibiotics, phage therapy, or synergistic combinations of phages and antibiotics, the impact of virus competition on the efficacy of antibiotic treatment has not yet been considered. Here, we model the synergy between antibiotics and two viral types, temperate and chronic, in controlling bacterial infections. We demonstrate that while combinations of antibiotic…
While the mechanisms and quantitative details are complex, few analysts would doubt that antibiotic use increases the prevalence of drug-resistant bacterial pathogens among all bacteria causing disease in a population. The causal connection between antibiotic use and the total incidence of severe bacterial infections, possibly mediated by antibiotic resistance, is less clearly established. The increasing burden of severe bacterial infections and their sequelae, particularly sepsis, in the United States and other countries, calls out for an explanation. In this Perspective we consider the evide…
Pathogenic bacteria present a large disease burden on human health. Control of these pathogens is hampered by rampant lateral gene transfer, whereby pathogenic strains may acquire genes conferring resistance to common antibiotics. Here we introduce tools from topological data analysis to characterize the frequency and scale of lateral gene transfer in bacteria, focusing on a set of pathogens of significant public health relevance. As a case study, we examine the spread of antibiotic resistance in Staphylococcus aureus. Finally, we consider the possible role of the human microbiome as a reservo…
Prolonged lag time can be induced by starvation contributing to the antibiotic tolerance of bacteria. We analyze the optimal lag time to survive and grow the iterative and stochastic application of antibiotics. A simple model shows that the optimal lag time exhibits a discontinuous transition when the severeness of the antibiotic is increased. This suggests the possibility of reducing tolerant bacteria by controlled usage of antibiotics application. When the bacterial populations are able to have two phenotypes with different lag times, the fraction of the second phenotype that has different l…
Antibiotic-resistant bacteria has posed a grave threat to public health by causing a number of nosocomial infections in hospitals. Mathematical models have been used to study the transmission of antibiotic-resistant bacteria within a hospital and the measures to control antibiotic resistance in nosocomial pathogens. Studies presented in \cite{LBL,LB} have shown great value in understanding the transmission of antibiotic-resistant bacteria in a hospital. However, their results are limited to numerical simulations of a few different scenarios without analytical analysis of the models in all biol…
The tolerance of bacterial populations to biocidal or antibiotic treatment has been well documented in both biofilm and planktonic settings. However, there is still very little known about the mechanisms that produce this tolerance. Evidence that small, non-mutant subpopulations of bacteria are not affected by antibiotic challenge has been accumulating and provides an attractive explanation for the failure of typical dosing protocols. Although a dosing challenge can kill all the susceptible bacteria, the remaining persister cells can serve as a source of population regrowth. We give a robust c…
The evolution of antibiotic resistance among bacteria threatens our continued ability to treat infectious diseases. The need for sustainable strategies to cure bacterial infections has never been greater. So far, all attempts to restore susceptibility after resistance has arisen have been unsuccessful, including restrictions on prescribing [1] and antibiotic cycling [2,3]. Part of the problem may be that those efforts have implemented different classes of unrelated antibiotics, and relied on removal of resistance by random loss of resistance genes from bacterial populations (drift). Here, we s…
Humans, domestic animals, orchard crops, and ornamental plants are commonly treated with antibiotics in response to bacterial infection. By curing infectious individuals, antibiotic therapy might limit the spread of contagious disease among hosts. But an antibiotic`s suppression of within-host pathogen density might also reduce the probability that the host is otherwise removed from infectious status prior to therapeutic recovery. When rates of both recovery via treatment and other removal events (e.g., isolation or mortality) depend directly on within-host pathogen density, antibiotic treatme…
Humans, domestic animals, orchard crops, and ornamental plants are commonly treated with antibiotics in response to bacterial infection. By curing infectious individuals, antibiotic therapy might limit the spread of contagious disease among hosts. But antibiotic suppression of within-host pathogen density might also reduce the probability that the host is otherwise removed from infectious status before recovery. When rates of both recovery and removal (isolation or mortality) depend directly on within-host density, antibiotic therapy can relax the removal rate and so increase between-host dise…
It has long been known that antibiotic treatment will not completely kill off a bacteria population. For many species a small fraction of bacteria is not sensitive to antibiotics. These bacteria are said to persist. Recently it has been shown that persistence is not a permanent state and that in fact a bacterium can switch back and forth between persistent and non persistent states. We introduce two stochastic models for bacteria persistence. In both models there are mass killings of non persistent bacteria at certain times. The first model has deterministic killing times and the second one ha…
Bacteria evolve resistance to antibiotics by a multitude of mechanisms. A central, yet unsolved question is how resistance evolution affects cell growth at different drug levels. Here we develop a fitness model that predicts growth rates of common resistance mutants from their effects on cell metabolism. We map metabolic effects of resistance mutations in drug-free environments and under drug challenge; the resulting fitness trade-off defines a Pareto surface of resistance evolution. We predict evolutionary trajectories of dosage-dependent growth rates and resistance levels, as well as the pre…
The rapid rise of antibiotic resistance is a serious threat to global public health. Without further incentives, pharmaceutical companies have little interest in developing antibiotics, since the success probability is low and development costs are huge. The situation is exacerbated by the "antibiotics dilemma": Developing narrow-spectrum antibiotics against resistant bacteria is most beneficial for society, but least attractive for companies since their usage is more limited than for broad-spectrum drugs and thus sales are low. Starting from a general mathematical framework for the study of a…
Optimization of sequential therapies to maximize extinction of resistant bacteria through collateral sensitivity
Universidad Carlos III de Madrid（马德里卡洛斯三世大学）；Grupo Interdisciplinar de Sistemas Complejos (GISC)（复杂系统跨学科小组 (GISC)）；Instituto de Biocomputación y Física de Sistemas Complejos, Universidad de Zaragoza（萨拉戈萨大学生物计算与复杂物理研究所）；Universidad Politécnica de Madrid（马德里理工大学）；Centro Nacional de Biotecnologia (CNB), CSIC（西班牙国家生物技术中心 (CNB)）
Nosocomial outbreaks of bacteria are well-documented. Based on these incidents, and the heavy usage of antibiotics in hospitals, it has been assumed that antibiotic resistance evolves in hospital environments. To test this assumption, we studied resistance phenotypes of bacteria collected from patient isolates at a community hospital over a 2.5-year period. A graphical model analysis shows no association between resistance and patient information other than time of arrival. This allows us to focus on time course data. We introduce a Hospital Transmission Model, based on negative binomial delay…
Conjugation is the primary mechanism of horizontal gene transfer that spreads antibiotic resistance among bacteria. Although conjugation normally occurs in surface-associated growth (e.g., biofilms), it has been traditionally studied in well-mixed liquid cultures lacking spatial structure, which is known to affect many evolutionary and ecological processes. Here we visualize spatial patterns of gene transfer mediated by F plasmid conjugation in a colony of Escherichia coli growing on solid agar, and we develop a quantitative understanding by spatial extension of traditional mass-action models.…
Antibiotic resistance is a growing public health problem. To gain a fundamental understanding of resistance evolution, a combination of systematic experimental and theoretical approaches is required. Evolution experiments combined with next-generation sequencing techniques, laboratory automation, and mathematical modeling are enabling the investigation of resistance development at an unprecedented level of detail. Recent work has directly tracked the intricate stochastic dynamics of bacterial populations in which resistant mutants emerge and compete. In addition, new approaches have enabled me…
Fitness landscapes are central in analyzing evolution, in particular for drug resistance mutations for bacteria and virus. We show that the fitness landscapes associated with antibiotic resistance are not compatible with any of the classical models; additive, uncorrelated and block fitness landscapes. The NK model is also discussed. It is frequently stated that virtually nothing is known about fitness landscapes in nature. We demonstrate that available records of antimicrobial drug mutations can reveal interesting properties of fitness landscapes in general. We apply the methods to analyze the…
The rise and spread of antibiotic resistance causes worsening medical cost and mortality especially for life-threatening bacteria infections, thereby posing a major threat to global health. Prescribing behavior of physicians is one of the important factors impacting the underlying dynamics of resistance evolution. It remains unclear when individual prescribing decisions can lead to the overuse of antibiotics on the population level, and whether population optimum of antibiotic use can be reached through an adaptive social learning process that governs the evolution of prescribing norm. Here we…
Antimicrobial resistance is a silent pandemic that is being exacerbated by the uncontrolled use of antibiotics. Since the discovery of penicillin, we have been largely dependent on microbe-derived small molecules to treat bacterial infections. However, the golden era of antibiotics is coming to an end as the emergence and spread of antimicrobial resistance against these antibacterial compounds is outpacing the discovery and development of new antibiotics. The current antibiotic market suffers from various shortcomings, including the absence of profitability and investment. However, the most im…
Since penicillin was discovered about 90 years ago, we have become used to using drugs to eradicate unwanted pathogenic cells. However, using drugs to kill bacteria, viruses or cancer cells has the serious side effect of selecting for mutant types that survive the drug attack. A key question therefore is how one could eradicate as many cells as possible for a given acceptable risk of drug resistance evolution. We address this general question in a model of drug resistance evolution in spatial drug gradients, which recent experiments and theories have suggested as key drivers of drug resistance…
The evolution and emergence of antibiotic resistance is a major public health concern. The understanding of the within-host microbial dynamics combining mutational processes, horizontal gene transfer and resource consumption, is one of the keys to solve this problem. We analyze a generic model to rigorously describe interactions dynamics of four bacterial strains: one fully sensitive to the drug, one with mutational resistance only, one with plasmidic resistance only and one with both resistances. By dening thresholds numbers (i.e. each strain's eective reproduction and each strain's transitio…
Mutation rate is a key determinant of the pace as well as outcome of evolution, and variability in this rate has been shown in different scenarios to play a key role in evolutionary adaptation and resistance evolution under stress caused by selective pressure. Here we investigate the dynamics of resistance fixation in a bacterial population with variable mutation rates and show that evolutionary outcomes are most sensitive to mutation rate variations when the population is subject to environmental and demographic conditions that suppress the evolutionary advantage of high-fitness subpopulation…
This paper develops a mathematical model describing the influence that conjugation-mediated Horizontal Gene Transfer (HGT) has on the mutation-selection balance in an asexually reproducing population of unicellular, prokaryotic organisms. It is assumed that mutation-selection balance is reached in the presence of a fixed background concentration of antibiotic, to which the population must become resistant in order to survive. We analyze the behavior of the model in the limit of low and high antibiotic-induced first-order death rate constants, and find that the highest mean fitness is obtained …
How adaptive evolution to one environmental stress improves or suppresses adaptation to another is an important problem in evolutionary biology. For instance, in microbiology, the evolution of bacteria to be resistant to different antibiotics is a critical issue that has been investigated as cross-resistance. In fact, recent experiments on bacteria have suggested that the cross-resistance of their evolution to various stressful environments can be predicted by the changes to their transcriptome upon application of stress. However, there are no studies so far that explain a possible theoretical…
