ArticleThe Journal of infectious diseases2015
Evidence for clonal expansion after antibiotic selection pressure: pneumococcal multilocus sequence types before and after mass azithromycin treatments.
Article in The Journal of infectious diseases, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 48 citations in OpenAlex.
- Infection prevention and control strategies for multidrug-resistant Gram-negative bacteria in healthcare: a narrative review.JAC-antimicrobial resistance · 2026Review
- Multiple Independent Origins of TnAntibiotics (Basel, Switzerland) · 2026Article
- Acquisition of a novel restriction modification system regulates genetic flux and gene expression in the hypervirulent and globally disseminated CC17 lineage of group B Streptococcus.Nucleic acids research · 2026Article
- A bacterial ecocline in Klebsiella pneumoniae may explain its backboned phylogeny.PLoS biology · 2026Article
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- Serotype distribution, antimicrobial susceptibility and molecular epidemiology of invasiveFrontiers in microbiology · 2023Article
- Impact of previous macrolide use on invasive pneumococcal disease due to erythromycin-resistant serotypes in adults over 59 years of age.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2022Article
- The impact of long-term azithromycin on antibiotic resistance in HIV-associated chronic lung disease.ERJ open research · 2022Article
- Mass drug administration with azithromycin for trachoma elimination and the population structure of Streptococcus pneumoniae in the nasopharynx.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2021Article
- Pneumococcal Competition Modulates Antibiotic Resistance in the Pre-Vaccination Era: A Modelling Study.Vaccines · 2021Article
- Antimicrobial Resistance Following Azithromycin Mass Drug Administration: Potential Surveillance Strategies to Assess Public Health Impact.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Genetic structures of invasive Streptococcus pneumoniae isolates from Korean children obtained between 1995 and 2013.BMC infectious diseases · 2018Article
- Antibiotic prophylaxis-Preventing severe infections and saving lives in poor countries with very high mortality risk.PLoS medicine · 2018Article
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- Macrolide-Resistant Mycoplasma pneumoniae Infection, Japan, 2008-2015.Emerging infectious diseases · 2017Article
- Deciphering the distance to antibiotic resistance for the pneumococcus using genome sequencing data.Scientific reports · 2017Article
- Macrolide Resistance inFrontiers in cellular and infection microbiology · 2016Review
- Macrolide resistance in pneumococci-is it relevant?Pneumonia (Nathan Qld.) · 2016Article
Corrections and comments
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Authors and funding
13 authors at 6 institutions in 3 countries.
Funding
Abstract
backgroundA clinical trial of mass azithromycin distributions for trachoma created a convenient experiment to test the hypothesis that antibiotic use selects for clonal expansion of preexisting resistant bacterial strains.
methodsTwelve communities in Ethiopia received mass azithromycin distributions every 3 months for 1 year. A random sample of 10 children aged 0-9 years from each community was monitored by means of nasopharyngeal swab sampling before mass azithromycin distribution and after 4 mass treatments. Swab specimens were tested for Streptococcus pneumoniae, and isolates underwent multilocus sequence typing.
resultsOf 82 pneumococcal isolates identified before treatment, 4 (5%) exhibited azithromycin resistance, representing 3 different sequence types (STs): 177, 6449, and 6494. The proportion of isolates that were classified as one of these 3 STs and were resistant to azithromycin increased after 4 mass azithromycin treatments (14 of 96 isolates [15%]; P = .04). Using a classification index, we found evidence for a relationship between ST and macrolide resistance after mass treatments (P < .0001). The diversity of STs-as calculated by the unbiased Simpson index-decreased significantly after mass azithromycin treatment (P = .045).
conclusionsResistant clones present before mass azithromycin treatments increased in frequency after treatment, consistent with the theory that antibiotic selection pressure results in clonal expansion of existing resistant strains.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.