Abstract
Antimicrobial Resistance in the Netherlands: A Natural Experiment?
Highlights
Use and misuse of antimicrobial agents lead to antimicrobial resistance
The Netherlands has the lowest human antibiotic consumption rate of Europe: this was 11.4 defined daily doses (DDD) per 1000 inhabitants/day in 2011; high antibiotic-consuming countries used three times as much (32.0 and 35.1 DDD per 1000 inhabitants/day in Cyprus and Greece, respectively) [6]. This country belongs to the large consumers of veterinary antibacterial agents in Europe: between 2005 and 2009 it had among the highest sales of antibiotics for veterinary use of 10 European countries investigated by Grave et al [7, 8]
Contamination with extended-spectrum beta-lactamases (ESBL)-producing strains was found in up to 90% of retail chicken meat samples [10, 11]. Another veterinary indicator of high antibiotic use is the massive colonization of Dutch pigs with methicillin-resistant Staphylococcus aureus (MRSA) [12]
Summary
This is well-known, as it is well known that restrictive use results in lower resistance rates. There are examples in the literature of changes in antibiotic use that have led to lowering resistance rates. In the hospital setting, lowering the use of specific antibiotics impacts resistance rates [3, 4].
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