A direct relation between antibiotic use and resistance has been shown at country level. We aim to investigate the association between antibiotic prescribing for patients from individual Dutch primary care practices and antibiotic resistance of bacterial isolates from routinely submitted urine samples from their patient populations. Practices’ antibiotic prescribing data were obtained from the Julius Network and related to numbers of registered patients. Practices were classified as low-, middle- or high-prescribers and from each group size-matching practices were chosen. Culture and susceptibility data from submitted urine samples were obtained from the microbiology laboratory. Percentages of resistant isolates, and resistant isolates per 1000 registered patients per year (population resistance) were calculated and compared between the groups. The percentages of resistant Escherichia coli varied considerably between individual practices, but the three prescribing groups’ means were very similar. However, as the higher-prescribing practices requested more urine cultures per 1000 registered patients, population resistance was markedly higher in the higher-prescribing groups. This study showed that the highly variable resistance percentages for individual practices were unrelated to antibiotic prescribing levels. However, population resistance (resistant strains per practice population) was related to antibiotic prescribing levels, which was shown to coincide with numbers of urine culture requests. Whether more urine culture requests in the higher-prescribing groups were related to treatment failures, more complex patient populations, or to general practitioners’ testing behaviour needs further investigation.

中文翻译：

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抗生素处方与耐药之间的实践水平关联：基层医疗的观察性研究。

在国家一级已显示出抗生素使用与耐药性之间的直接关系。我们的目的是调查从荷兰个人初级保健实践中为患者开出的抗生素处方与从患者群中定期提交的尿液样本中分离出的细菌的耐药性之间的关系。从朱利叶斯网络（Julius Network）获得实践的抗生素处方数据，并与注册患者的数量有关。将实践分为低，中，高处方者，并从每个组中选择规模匹配的实践。来自提交的尿液样本的培养和药敏性数据是从微生物学实验室获得的。计算抗药性菌株的百分率，以及每年每1000名登记患者中的抗药性菌株的比例（人口抗药性），并在两组之间进行比较。大肠杆菌各个实践之间的差异很大，但是三个处方组的含义非常相似。但是，由于较高处方的做法要求每千名注册患者进行更多尿液培养，因此较高处方组的人群抵抗力明显更高。这项研究表明，针对个体使用情况的高耐药百分率与抗生素处方水平无关。但是，人群的耐药性（每个练习人群的耐药菌株）与抗生素的处方水平有关，这与尿液培养的要求数量相吻合。在较高处方组中更多的尿培养要求是否与治疗失败，更复杂的患者人群或全科医生的测试行为有关，需要进一步调查。