ArticleProceedings of the National Academy of Sciences of the United States of America2020
The role of "spillover" in antibiotic resistance.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers.
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The trial behind it
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Who cites it
32 citing papers in PubMed.
- Mass azithromycin distribution and antibiotic resistance in the gut and nasopharynx: a cluster-randomized trial.Nature medicine · 2026Trial
- Trial
- Assessment of Spillover of Antimicrobial Resistance to Untreated Children 7-12 Years Old After Mass Drug Administration of Azithromycin for Child Survival in Niger: A Secondary Analysis of the MORDOR Cluster-Randomized Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Trial
- Prolonged mass azithromycin distributions and macrolide resistance determinants among preschool children in Niger: A sub-study of a cluster-randomized trial (MORDOR).PLoS medicine · 2024Trial
- Temporal Trends in Phenotypic Macrolide and Nonmacrolide Resistance for Streptococcus pneumoniae Nasopharyngeal Samples Up to 36 Months after Mass Azithromycin Administration in a Cluster-Randomized Trial in Niger.The American journal of tropical medicine and hygiene · 2023Trial
- Assessment of Long-Term Macrolide Exposure on the Oropharyngeal Microbiome and Macrolide Resistance in Healthy Adults and Consequences for Onward Transmission of Resistance.Antimicrobial agents and chemotherapy · 2022Trial
- Gut Resistome of Preschool Children After Prolonged Mass Azithromycin Distribution: A Cluster-randomized Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Trial
- Reported Dosing-Related Medication Errors Involving Systemic Antibiotics in the Brazilian Pharmacovigilance Database (2018-2025): Distribution Across the WHO AWaRe Classification.Pharmacoepidemiology and drug safety · 2026Article
- Article
- Genomic surveillance ofMicrobial genomics · 2026Article
- Geographic spillover of antimicrobial resistance from mass distribution of azithromycin.Nature communications · 2026Article
- Institutional spillover effects of antimicrobial use on antimicrobial resistance andAntimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Geographic spillover of antimicrobial resistance from mass distribution of azithromycin.medRxiv : the preprint server for health sciences · 2025Article
- Mass drug administration trials of azithromycin: an analysis to inform future research and guidelines.Infectious diseases of poverty · 2025Review
- Switching From Dual to Monotherapy for Gonorrhea is Associated With a Halving of Gonococcal Resistance to Azithromycin-A Modelling Study of MSM in Belgium.Open forum infectious diseases · 2025Article
- The evolution of antibiotic resistance in Europe, 1998-2019.PLoS pathogens · 2025Article
- Three-year impact of COVID-19 pandemic on hospitalized twin pregnancies: evaluation of characteristics and changes in antibiotic prescribing.Frontiers in medicine · 2025Article
- Article
- Wastewater-Based Surveillance of Antimicrobial Resistance in Niger: An Exploratory Study.The American journal of tropical medicine and hygiene · 2023Article
- Antimicrobial Resistance in Ventilator-Associated Pneumonia: Predictive Microbiology and Evidence-Based Therapy.Infectious diseases and therapy · 2023Review
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
Antibiotic use is a key driver of antibiotic resistance. Understanding the quantitative association between antibiotic use and resulting resistance is important for predicting future rates of antibiotic resistance and for designing antibiotic stewardship policy. However, the use-resistance association is complicated by "spillover," in which one population's level of antibiotic use affects another population's level of resistance via the transmission of bacteria between those populations. Spillover is known to have effects at the level of families and hospitals, but it is unclear if spillover is relevant at larger scales. We used mathematical modeling and analysis of observational data to address this question. First, we used dynamical models of antibiotic resistance to predict the effects of spillover. Whereas populations completely isolated from one another do not experience any spillover, we found that if even 1% of interactions are between populations, then spillover may have large consequences: The effect of a change in antibiotic use in one population on antibiotic resistance in that population could be reduced by as much as 50%. Then, we quantified spillover in observational antibiotic use and resistance data from US states and European countries for three pathogen-antibiotic combinations, finding that increased interactions between populations were associated with smaller differences in antibiotic resistance between those populations. Thus, spillover may have an important impact at the level of states and countries, which has ramifications for predicting the future of antibiotic resistance, designing antibiotic resistance stewardship policy, and interpreting stewardship interventions.
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