Shepherd, Matthew J, Fu, Taoran, Harrington, Niamh E, Kottara, Anastasia, Cagney, Kendall, Chalmers, James D, Paterson, Steve 
ORCID: 0000-0002-1307-2981, Fothergill, Joanne L ORCID: 0000-0002-7012-1508 and Brockhurst, Michael A
(2024)
Ecological and evolutionary mechanisms driving within-patient emergence of antimicrobial resistance.
Nature Reviews Microbiology.
pp. 1-16.
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s41579-024-01041-1.pdf - Author Accepted Manuscript Available under License Creative Commons Attribution. Download (3MB) | Preview |
Abstract
The ecological and evolutionary mechanisms of antimicrobial resistance (AMR) emergence within patients and how these vary across bacterial infections are poorly understood. Increasingly widespread use of pathogen genome sequencing in the clinic enables a deeper understanding of these processes. In this Review, we explore the clinical evidence to support four major mechanisms of within-patient AMR emergence in bacteria: spontaneous resistance mutations; in situ horizontal gene transfer of resistance genes; selection of pre-existing resistance; and immigration of resistant lineages. Within-patient AMR emergence occurs across a wide range of host niches and bacterial species, but the importance of each mechanism varies between bacterial species and infection sites within the body. We identify potential drivers of such differences and discuss how ecological and evolutionary analysis could be embedded within clinical trials of antimicrobials, which are powerful but underused tools for understanding why these mechanisms vary between pathogens, infections and individuals. Ultimately, improving understanding of how host niche, bacterial species and antibiotic mode of action combine to govern the ecological and evolutionary mechanism of AMR emergence in patients will enable more predictive and personalized diagnosis and antimicrobial therapies.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Infectious Diseases, Antimicrobial Resistance, Genetics, 2 Aetiology, 2.2 Factors relating to the physical environment, Infection, 3 Good Health and Well Being |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 02 May 2024 07:23 |
| Last Modified: | 08 May 2024 16:37 |
| DOI: | 10.1038/s41579-024-01041-1 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3180717 |
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