Resistant or resilient? Defining antibiotic responses could help to preserve them

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More focus should be put on determining if pathogens are resistant or resilient to antibiotics, according to new research published in Science Advances.

The new study demonstrates there is more than one type of antibiotic resistance, arguing that this should be taken account of in order to personalize treatment and to help preserve these drugs.

The researchers tracked the population of several beta-lactam-tolerant strains of bacteria while they were exposed to beta-lactam antibiotics, using the responses to quantify the population’s level of resistance or resilience – the first time there has been a method to attribute a value to this factor.

Resistant strains see little disturbance to population levels when faced with an antibiotic; however, resilient strains suffer a population crash before the community can secrete sufficient enzymes to degrade the antibiotic to a tolerable level. The researchers argue that by testing an infecting pathogen and only checking the end results this important difference is missed.

Author, Lingchong You (Duke University, NC, USA), commented: “Clinicians have not historically distinguished between these two scenarios but as beta-lactam-tolerant pathogens become more common, I believe this distinction could become extremely important.”

The study offers a framework to design tests that could measure the resilience or resistance of an infection, and You feels this procedure will become more common. For example, if a strain was known to be resilient antibiotics could be administered at the infection’s weakest point, allowing first-line antibiotics to be used in what might otherwise have been considered a resistant infection.

You concluded: “We’re still in a stage where doctors don’t do a detailed diagnosis of what specific infection a patient is suffering from, they just prescribe these antibiotics because they’ll probably work after 2 weeks. And if they don’t, they’ll just try a different one.”

“But I think as these beta-lactam-resistant strains continue to spread around the world and become more common, our diagnoses will have to catch up so we can provide more tailored dosing protocols.”

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Sources: Meredith H, Adreani V, Lopatkin A et al. Applying ecological resistance and resilience to dissect bacterial antibiotic responses. Science Advances. doi:10.1126/sciadv.aau1873 (2018); www.eurekalert.org/emb_releases/2018-12/du-drf120318.php

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