ArticleThe Lancet. Microbe2021
Identification of antibiotic pairs that evade concurrent resistance via a retrospective analysis of antimicrobial susceptibility test results.
Article in The Lancet. Microbe, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 41 citations in OpenAlex.
- Evolutionary drivers of divergent collateral sensitivity responses during antibiotic therapy.Nature ecology & evolution · 2026Review
- Multidrug antibiotic resistance index and antimicrobial resistance patterns of Escherichia coli in intensive pig farms in Kenya.One health outlook · 2025Article
- EvoWeaver: large-scale prediction of gene functional associations from coevolutionary signals.Nature communications · 2025Article
- Dynamic collateral sensitivity profiles highlight opportunities and challenges for optimizing antibiotic treatments.PLoS biology · 2025Article
- Drug combinations targeting antibiotic resistance.npj antimicrobials and resistance · 2024Review
- Vancomycin-resistant Staphylococcus aureus (VRSA) can overcome the cost of antibiotic resistance and may threaten vancomycin's clinical durability.PLoS pathogens · 2024Article
- Preserving the efficacy of antibiotics to tackle antibiotic resistance.Microbial biotechnology · 2024Review
- A study of antibiotic resistance pattern of clinical bacterial pathogens isolated from patients in a tertiary care hospital.Frontiers in microbiology · 2024Article
- Cost-Efficient Micro-Well Array-Based Colorimetric Antibiotic Susceptibility Testing (MacAST) for Bacteria from Culture or Community.Biosensors · 2023Article
- Fitness Costs of Antibiotic Resistance Impede the Evolution of Resistance to Other Antibiotics.ACS infectious diseases · 2023Article
- What are the missing pieces needed to stop antibiotic resistance?Microbial biotechnology · 2023Review
- Translating eco-evolutionary biology into therapy to tackle antibiotic resistance.Nature reviews. Microbiology · 2023Review
- Bayesian network modeling of patterns of antibiotic cross-resistance by bacterial sample source.Communications medicine · 2023Article
- Mutations inmBio · 2023Article
- Tackling antibiotic resistance by inducing transient and robust collateral sensitivity.Nature communications · 2023Article
- Prediction of ciprofloxacin resistance in hospitalized patients using machine learning.Communications medicine · 2023Article
- Rapid Phenotypic Convergence towards Collateral Sensitivity in Clinical Isolates of Pseudomonas aeruginosa Presenting Different Genomic Backgrounds.Microbiology spectrum · 2023Article
- A Small KPC-2-Producing Plasmid inMicrobiology spectrum · 2022Article
- Expanding the search for small-molecule antibacterials by multidimensional profiling.Nature chemical biology · 2022Review
- Quantifying the Relationship between Antibiotic Use in Food-Producing Animals and Antibiotic Resistance in Humans.Antibiotics (Basel, Switzerland) · 2022Article
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
- Commented on by
Authors and funding
2 authors at 1 institution in 1 country.
Funding
Abstract
backgroundSome antibiotic pairs display a property known as collateral sensitivity in which the evolution of resistance to one antibiotic increases sensitivity to the other. Alternating between collaterally sensitive antibiotics has been proposed as a sustainable solution to the problem of antibiotic resistance. We aimed to identify antibiotic pairs that could be considered for treatment strategies based on alternating antibiotics.
methodsWe did a retrospective analysis of 448 563 antimicrobial susceptibility test results acquired over a 4-year period (Jan 1, 2015, to Dec 31, 2018) from 23 hospitals in the University of Pittsburgh Medical Center (Pittsburgh, PA, USA) hospital system. We used a score based on mutual information to identify pairs of antibiotics displaying disjoint resistance, wherein resistance to one antibiotic is commonly associated with susceptibility to the other and vice versa. We applied this approach to the six most frequently isolated bacterial pathogens (
findingsWe identified 69 antibiotic pairs displaying varying degrees of disjoint resistance for subpopulations of the six bacterial species. However, disjoint resistance was rarely conserved at the species level, with only 6 (0·7%) of 875 antibiotic pairs showing evidence of disjoint resistance. Instead, more than half of antibiotic pairs (465 [53·1%] of 875) exhibited signatures of concurrent resistance, whereby resistance to one antibiotic is associated with resistance to another. We found concurrent resistance to extend to more than two antibiotics, with observed rates of resistance to three antibiotics being higher than predicted from pairwise information alone.
interpretationThe high frequency of concurrent resistance shows that bacteria have means of counteracting multiple antibiotics at a time. The almost complete absence of disjoint resistance at the species level implies that treatment strategies based on alternating between antibiotics might require subspecies level pathogen identification and be limited to a few antibiotic pairings.
fundingUS National Institutes of Health.
Indexed as
Identifiers
What OpenQuestion holds
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.