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bioRxiv · 10.1101/473769

The distribution of antibiotic use and its association with antibiotic resistance

Olesen, S. W.·Barnett, M. L.·MacFadden, D. R.·Brownstein, J. S.·Hernandez-Diaz, S.·Lipsitch, M.·Grad, Y. H.
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Abstract

Antibiotic use is a primary driver of antibiotic resistance. However, antibiotic use can be distributed in different ways in a population, and the association between the distribution of use and antibiotic resistance has not been explored. Here we tested the hypothesis that repeated use of antibiotics has a stronger association with population-wide antibiotic resistance than broadly- distributed, low-intensity use. First, we characterized the distribution of outpatient antibiotic use across US states, finding that antibiotic use is uneven and that repeated use of antibiotics makes up a minority of antibiotic use. Second, we compared antibiotic use with resistance for 72 pathogen-antibiotic combinations across states. Finally, having partitioned total use into extensive and intensive margins, we found that intense use had a weaker association with resistance than extensive use. If the use-resistance relationship is causal, these results suggest that reducing total use and selection intensity will require reducing broadly-distributed, low- intensity use.

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Olesen, S. W., Barnett, M. L., MacFadden, D. R., Brownstein, J. S., Hernandez-Diaz, S., Lipsitch, M., Grad, Y. H.. 2018-11-19. The distribution of antibiotic use and its association with antibiotic resistance. https://doi.org/10.1101/473769

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