Practice-Level Association between Antibiotic Prescribing and Resistance: An Observational Study in Primary Care

Abstract

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.

Editorial: Antibiotics Special Issue on the Use of Antibiotics in Primary Care

“…Batenburg et al [ 12 ] illustrates the methodological challenges in quantifying the role of prescribing styles (i.e., the personal tendency to prescribe antibiotics) in the development and spread of AMR at the primary care level. Although the analysis is performed on data from primary care in the Netherlands, the methodological challenges apply to all settings where, despite having an excellent IT infrastructure supporting the surveillance of antimicrobial use and antimicrobial resistance, there are still important gaps regarding the correct processes to carry out surveillance of AMR inprimary care.…”