This conversation was led by Robert Woods, MD, PhD, Assistant Professor in the Devision of Infectious Diseases at the University of Michigan Medical School. Antimicrobial resistance is among the clearest examples of evolution in action. Indeed, experimental resistance studies are often used to advance fundamental evolutionary science, and antimicrobial resistance featured in both introductory and advanced curricula in evolutionary biology courses. Moreover, the global antibiotic resistance crisis is among the most pressing public health threats faced by modern medicine. Despite the obvious role for evolutionary biology to lead us through this crisis, the evidence for a tangible impact of evolutionary theory on antibiotic treatment decisions is vanishingly rare. The focus of this talk was to better understand the barriers to translating evolutionary theory into antimicrobial treatment decisions. Case studies from Woods’ personal practice were used to highlight the challenge in making evidence-based, theory-driven decisions about antibiotic therapy, even in situations in which the emergence of resistance is fully anticipated. He used these cases to discuss the clinical manifestation of antibiotic resistance, how these clinical manifestations map onto underlying evolutionary forces, and ultimately suggest treatment strategies.
Through this description we can see both technological barriers, such as insufficient sampling and testing of complex communities, and fundamental conceptual barriers, such as the determinants of chance and predictability in evolution. Woods proposed that the way forward will require conceptual clarity and a common vocabulary across the diverse stakeholders in the resistance crisis. Additionally, he discussed potential clinical studies that would allow us to link clinical manifestations of resistance and evolutionary processes with specific antibiotic treatment decisions. Such studies will hasten the development of evolution-informed antimicrobial treatment strategies.
After the talk, additional perspectives on how the research applies in a clinical setting were presented by John LiPuma, MD, pediatric infectious disease specialist at the University of Michigan Mott Children’s Hospital.
- Zhou et al. 2020, “Why is preventing antibiotic resistance so hard? Analysis of failed resistance management”
- Woods and Read 2015, “Clinical management of resistance evolution in a bacterial infection: A case study”