Hygiene may attenuate selection for antibiotic resistance by changing microbial community structure

Good hygiene, in both health care and the community, is central to containing the rise of antibiotic resistance, as well as to infection control more generally. But despite the well-known importance, the ecological mechanisms by which hygiene (or other transmission control measures) affect the evolution of resistance remain to be elucidated. Using metacommunity ecology theory, we here propose that hygiene attenuates the effect of antibiotic selection pressure. Specifically, we predict that hygiene limits the scope for antibiotics to induce competitive release of resistant bacteria within treated hosts, and that this is due to an effect of hygiene on the distribution of resistant and sensitive strains in the host population. We show this in a mathematical model of bacterial metacommunity dynamics, and test the results against data on antibiotic resistance, antibiotic treatment, and the use of alcohol-based hand rub in long-term care facilities. The data are consistent with hand rub use attenuating the resistance promoting effect of antibiotic treatment. Our results underscore the importance of hygiene, and point to a concrete way to weaken the link between antibiotic use and increasing resistance. Hygiene and antibiotic use are important levers in the work to limit resistance evolution. We study how they interact, and find that hygiene can attenuate the effect of antibiotic pressure on the rate of evolution.

Automated summary

Good hygiene is crucial for controlling the rise of antibiotic resistance and infection control. However, the ecological mechanisms by which hygiene affects resistance evolution have yet to be fully understood. This study proposes that hygiene limits the competitive release of resistant bacteria by antibiotic treatment, based on mathematical models and data analysis.