Biology subjects

Kishony, R.

Publications and source records attributed to Kishony, R..

3 recordsLinked to original sources

bioRxiv2018

Personal clinical history predicts antibiotic resistance in urinary tract infections

The prevalence of antibiotic resistance in urinary tract infections (UTIs) often renders the prescribed antimicrobial treatment ineffective, highlighting the need for personalized prediction of resistance at time of care. Here, crossing a 10-year longitudinal dataset of over 700,000 community-acquired UTIs with over 6,000,000 personally-linked records of antibiotic purchases, we show that the resistance profile of infections can be predicted based on patient-specific demographics and clinical history. Age, gender, and retirement home residence had strong, yet differential and even non-monotonic, associations with resistance to different antibiotics. Resistance profiles were also associated with the patients records of past urine samples and antibiotic usage, with these associations persisting for months and even longer than a year. Drug usage selected specifically for its own cognate resistance, which led indirectly, through genetic linkage, also to resistance to other, even mechanistically unrelated, drugs. Applying machine learning models, these association patterns allowed good personalized predictions of resistance, which could inform and better optimize empirical prescription of antibiotics.

epidemiology↗

bioRxiv2017

The null additivity of multi-drug combinations

From natural ecology 1-4 to clinical therapy 5-8, cells are often exposed to mixtures of multiple drugs. Two competing null models are used to predict the combined effect of drugs: response additivity (Bliss) and dosage additivity (Loewe) 9-11. Here, noting that these models diverge with increased number of drugs, we contrast their predictions with measurements of Escherichia coli growth under combinations of up to 10 different antibiotics. As the number of drugs increases, Bliss maintains accuracy while Loewe systematically loses its predictive power. The total dosage required for growth inhibition, which Loewe predicts should be fixed, steadily increases with the number of drugs, following a square root scaling. This scaling is explained by an approximation to Bliss where, inspired by RA Fishers classical geometric model 12, dosages of independent drugs adds up as orthogonal vectors rather than linearly. This dose-orthogonality approximation provides results similar to Bliss, yet uses the dosage language as Loewe and is hence easier to implement and intuit. The rejection of dosage additivity in favor of effect additivity and dosage orthogonality provides a framework for understanding how multiple drugs and stressors add up in nature and the clinic.

systems biology↗

bioRxiv2016

Population diversity jeopardizes the efficacy of antibiotic cycling

Treatment strategies that anticipate and respond to the evolution of pathogens are promising tools for combating the global rise of antibiotic resistance1-3. Mutations conferring resistance to one drug can confer positive or negative cross-resistance to other drugs4. The sequential use of drugs exhibiting negative cross-resistance has been proposed to prevent or slow down the evolution of resistance5-8, although factors affecting its efficacy have not been investigated. Here we show that population diversity can disrupt the efficacy of negative cross-resistance-based therapies. By testing 3317 resistant Staphylococcus aureus mutants against multiple antibiotics, we show that first-step mutants exhibit diverse cross-resistance profiles: even when the majority of mutants show negative cross-resistance, rare positive cross-resistant mutants can appear. Using a drug pair showing reciprocal negative cross-resistance, we found that selection for resistance to the first drug in small populations can decrease resistance to the second drug, but identical selection conditions in large populations can increases resistance to the second drug through the appearance of rare positive cross-resistant mutants. We further find that, even with small populations and strong bottlenecks, resistance to both drugs can increase through sequential steps of negative cross-resistance cycling. Thus, low diversity is necessary but not sufficient for effective cycling therapies. While evolutionary interventions are promising tools for controlling antibiotic resistance, they can be sensitive to population diversity and the accessibility of evolutionary paths, and so must be carefully designed to avoid harmful outcomes.

microbiology↗