Antibiotic resistance in specific sociodemographic groups Implications for public health

The overall aim of this thesis was to describe the occurrence of and associated factors with antibiotic resistance among specific sociodemographic groups living in Amsterdam, the Netherlands. This thesis focused on (I) antibiotic knowledge, antibiotic use and prevalence of MRSA among different ethnic groups, (II) prevalence of ESBL-E among MSM and residents of long-term care facilities, and (III) perceived barriers and facilitating factors for preventing the spread of carbapenemase producing gram-negative bacteria during patient transfers between healthcare providers. The studies presented in this thesis have provided insight into the occurrence of and risk factors for antibiotic resistance among specific demographic groups living in Amsterdam, the Netherlands, and have elaborated on the implications for public health. Furthermore, this thesis has provided several recommendations for actions that could help combat ABR in public health and within the cascade of care in the Netherlands. Specific recommendations include launching a differentiated prevention message to educate individuals from different ethnic groups on antibiotics and ABR, to inform sexually active MSM of their increased risk of ESBL-E carriage and the association with sexual behavior, to inform healthcare providers about ethnic differences in antibiotic use and about the increased prevalence of EBSL-E carriage among MSM and the association with sexual behavior, to study MRSA carriage among a wide array of migrants, to make formal transmural agreements on CPB and to improve and expand SNIV. We believe that the RIVM, regional ABR care networks, local public health services and professionals from hospitals, long term care facilities, primary care facilities, research institutes and non-governmental organizations (NGO’s) should join forces to help combat ABR in the Netherlands.