TY - JOUR AU - Lipsitch, Marc AU - Samore, Matthew T1 - Antimicrobial Use and Antimicrobial Resistance: A Population Perspective T2 - Emerging Infectious Disease journal PY - 2002 VL - 8 IS - 4 SP - 347 SN - 1080-6059 AB - The need to stem the growing problem of antimicrobial resistance has prompted multiple, sometimes conflicting, calls for changes in the use of antimicrobial agents. One source of disagreement concerns the major mechanisms by which antibiotics select resistant strains. For infections like tuberculosis, in which resistance can emerge in treated hosts through mutation, prevention of antimicrobial resistance in individual hosts is a primary method of preventing the spread of resistant organisms in the community. By contrast, for many other important resistant pathogens, such as penicillin-resistant Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus faecium resistance is mediated by the acquisition of genes or gene fragments by horizontal transfer; resistance in the treated host is a relatively rare event. For these organisms, indirect, population-level mechanisms of selection account for the increase in the prevalence of resistance. These mechanisms can operate even when treatment has a modest, or even negative, effect on an individual host’s colonization with resistant organisms. KW - Antimicrobial resistance KW - population dynamics KW - mathematical model KW - infectious disease transmission KW - ecological study KW - epidemiologic methods KW - United States DO - 10.3201/eid0804.010312 UR - https://wwwnc.cdc.gov/eid/article/8/4/01-0312_article ER - End of Reference