Evidence map›Paper›PMID 41617894›Full record

ArticleNature microbiology2026

Quantifying the real-world impact of antibiotic use and genetic determinants of resistance on gonococcal dynamics.

David Helekal, Tatum D Mortimer, Aditi Mukherjee, Gabriella Gentile, Adriana Le Van, Sofia Blomqvist, Robert A Nicholas, Ann E Jerse, Samantha G Palace, Yonatan H Grad

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Nature microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Heterogeneity of azithromycin resistance markers inNew microbes and new infections · 2026
    Review
  2. Article
  3. Fluoroquinolone resistance-conferringbioRxiv : the preprint server for biology · 2026
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

David HelekalDepartment of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Tatum D MortimerDepartment of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.ORCID http://orcid.org/0000-0001-6255-690X
Aditi MukherjeeDepartment of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA.ORCID http://orcid.org/0000-0002-2208-9945
Gabriella GentileDepartment of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.ORCID http://orcid.org/0000-0002-8809-0260
Adriana Le VanDepartment of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Sofia BlomqvistDepartment of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA.ORCID http://orcid.org/0000-0002-8967-3564
Robert A NicholasDepartment of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Ann E JerseDepartment of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Samantha G PalaceDepartment of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA.ORCID http://orcid.org/0000-0002-7849-8078
Yonatan H GradDepartment of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA. ygrad@hsph.harvard.edu.ORCID http://orcid.org/0000-0001-5646-1314

Funding

Genomics approaches to elucidating pathways to antibiotic resistance in Neisseria gonorrhoeaeR01AI132606 · NIAID · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI Yonatan H Grad · 2017 to 2026
$3.8M
Identification and analysis of compensatory mutations that support the evolution of antibiotic resistance in Neisseria gonorrhoeaeR01AI153521 · NIAID · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI GRAD, YONATAN H, JERSE, ANN E. · 2020 to 2024
$3.7M
NIAID NIH HHS R01 AI132606NIAID NIH HHS R01 AI153521
6 · The paper itself

Abstract

The dynamics of antimicrobial resistance in bacterial populations are influenced by the fitness impact of genetic determinants of resistance and antibiotic pressure. However, estimates of real-world fitness impact have been lacking. To address this gap, we developed a hierarchical Bayesian phylodynamic model to quantify contributions of resistance determinants to strain success in a 20-year collection of Neisseria gonorrhoeae isolates. Fitness contributions varied with antibiotic use, which over this period included ciprofloxacin, cefixime, ceftriaxone and azithromycin, and genetic pathways to phenotypically identical resistance conferred distinct fitness effects. These findings were supported by competition experiments both in vitro and in the mouse model of gonococcal infection. Quantifying these fitness contributions to lineage dynamics reveals opportunities for investigation into other genetic and environmental drivers of fitness. This work thus establishes a method for linking pathogen genomics and antibiotic use to define factors shaping ecological trends.

Indexed as

Anti-Bacterial AgentsDrug Resistance, BacterialGonorrheaNeisseria gonorrhoeaeAnimalsBayes TheoremCiprofloxacinDisease Models, AnimalGenetic FitnessHumansMiceMicrobial Sensitivity TestsThird Generation CephalosporinsAnti-Bacterial AgentsCiprofloxacinThird Generation Cephalosporins

Identifiers

PMID41617894
PMCPMC12872460

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

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.