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抗菌化疗的宿主内种群动态:耐药性进化的条件

The within-host population dynamics of antibacterial chemotherapy: conditions for the evolution of resistance.

作者信息

Lipsitch M, Levin B R

机构信息

Department of Biology, Emory University, Atlanta, GA 30322, USA.

出版信息

Ciba Found Symp. 1997;207:112-27; discussion 127-30. doi: 10.1002/9780470515358.ch8.

Abstract

For tuberculosis and number of other bacterial infections, treatment with a single antimicrobial drug frequently fails due to the ascent of mutants resistant to that drug. To minimize the likelihood of this occurrence, multiple drugs with independent resistance mechanisms are used simultaneously. None the less, multiply resistant bacteria sometimes emerge even when patients are simultaneously treated with two or more drugs, and the ascent of these multiply-resistant mutants may result in treatment failure in the patient and spread of these resistant bacteria to other hosts. We consider two mathematical models of antibacterial chemotherapy which can account for the ascent of multiple antibiotic resistance within hosts treated with multiple antibiotics. In both, multiple resistance evolves because of selection favouring mutants resistant to fewer than all of the chemotherapeutic agents employed, intermediates. In one model, this occurs because of temporal fluctuations in the concentrations of the antibiotics in the course of normal treatment and/or because of non-adherence to the treatment regime. In the other, intermediates are favoured and multiple resistance evolves because of tissue and somatic cell heterogeneity. In the effective concentrations of the antibiotics and physiological variation in the sensitivity of subpopulations of bacteria to different antibiotics. We discuss the limitations (and assets) of this model and approach and the implications for the design of antibiotic treatment regimes. Finally, we consider how the assumptions behind this model and the predictions made from its analysis could be tested experimentally.

摘要

对于结核病和许多其他细菌感染,由于对单一抗菌药物产生耐药性的突变体的出现,使用单一抗菌药物进行治疗常常会失败。为了尽量减少这种情况发生的可能性,通常会同时使用多种具有独立耐药机制的药物。然而,即使患者同时接受两种或更多种药物治疗,有时仍会出现多重耐药细菌,这些多重耐药突变体的出现可能导致患者治疗失败,并使这些耐药细菌传播到其他宿主。我们考虑了两种抗菌化疗的数学模型,它们可以解释在用多种抗生素治疗的宿主体内多重抗生素耐药性的出现。在这两种模型中,多重耐药性的产生是因为选择有利于对所用化疗药物中少于全部药物耐药的突变体,即中间型。在一个模型中,这是由于在正常治疗过程中抗生素浓度的时间波动和/或由于不遵守治疗方案而发生的。在另一个模型中,中间型受到青睐,多重耐药性的产生是由于组织和体细胞的异质性,以及抗生素的有效浓度和细菌亚群对不同抗生素敏感性的生理变化。我们讨论了该模型和方法的局限性(及优点)以及对抗生素治疗方案设计的影响。最后,我们考虑如何通过实验来检验该模型背后的假设及其分析所做出的预测。

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