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：

---

抗生素处方与耐药性之间的实践水平关联：初级保健观察性研究。


抗生素使用与耐药性之间的直接关系已在国家层面得到证实。我们的目的是调查荷兰个体初级保健实践中为患者开具的抗生素处方与患者群体常规提交的尿液样本中分离出的细菌的抗生素耐药性之间的关系。诊所的抗生素处方数据来自 Julius Network，与登记患者数量相关。诊所被分为低、中或高处方者，并从每个组中选择大小匹配的诊所。提交的尿液样本的培养和药敏数据是从微生物实验室获得的。计算并比较各组之间的耐药菌株百分比以及每年每 1000 名登记患者中的耐药菌株（群体耐药性）。不同实践中耐药大肠杆菌的百分比差异很大，但三个处方组的平均值非常相似。然而，由于较高处方的做法要求每 1000 名登记患者进行更多的尿培养，因此较高处方组的人群抵抗力明显较高。这项研究表明，个体实践中高度可变的耐药性百分比与抗生素处方水平无关。然而，人群耐药性（每个实践人群的耐药菌株）与抗生素处方水平有关，这与尿培养要求的数量一致。较高处方组中更多的尿培养要求是否与治疗失败、更复杂的患者群体或全科医生的检测行为有关，需要进一步调查。