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

The Nature Microbiology study “Quantifying the real-world impact of antibiotic use and genetic determinants of resistance on gonococcal dynamics” develops a hierarchical Bayesian phylodynamic model to link longitudinal Neisseria gonorrhoeae genomic data with patterns of antibiotic use over 20 years in the United States, enabling quantification of how individual genetic resistance determinants influence strain success under changing antibiotic pressures; the authors show that the fitness effects of specific resistance mutations vary with treatment regimens (e.g., fluoroquinolones, cephalosporins, macrolides), that phenotypically similar resistance mutations can confer divergent fitness impacts, and that compensatory dynamics (loss or gain of determinants) shape lineage trajectories, thereby establishing a quantitative framework for parsing the real-world ecological consequences of AMR evolution in a major human pathogen.