Is selection relevant in the evolutionary emergence of drug resistance?

摘要

The emergence of drug resistant pathogens is often considered a canonical case of evolution by ‘natural’ selection. Here we argue that the strength of selection can be a poor predictor of the rate of resistance emergence. It is possible for a resistant strain to be under negative selection and still emerge in an infection or spread in a population. Measuring the right parameters is a necessary first step towards the development of evidence-based resistance management strategies. We argue that it is the absolute fitness of the resistant strains that matters most, and that a primary determinant of the absolute fitness of a resistant strain when it arises is the ecological context in which it finds itself.