Join us for a conversation with 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. 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 is to better understand the barriers to translating evolutionary theory into antimicrobial treatment decisions. Case studies from my personal practice will be 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. I will use 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. I propose that the way forward will require conceptual clarity and a common vocabulary across the diverse stakeholders in the resistance crisis. Additionally, I will discuss 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.