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Significance Bystander selection, defined as the inadvertent pressure imposed by antibiotic treatment on microbes other than the targeted pathogen, is hypothesized to be a major factor in the propagation of antibiotic resistance, but its extent has not been characterized. We estimate the proportion of bystander exposures across a range of antibiotics and potential pathogens commonly found in the normal flora and describe factors driving variability of these proportions. Impact estimates for antibiotic resistance interventions, including vaccination, are often limited to effects on a target pathogen. However, the reduction of antibiotic treatment for conditions caused by one pathogen may have the broader potential to decrease bystander selection pressures for resistance on many other organisms.

Estimating the proportion of bystander selection for antibiotic resistance among potentially pathogenic bacterial flora