Antimicrobial use and resistance in hospitalized patients

The general aim of the studies in this thesis was to explore the current emergence of antibiotic resistance in hospitals. This aim is addressed in two research projects. The first project concerns the optimization of surveillance of quantitative antibiotic use in hospitals. Studies are performed in which the interpretation of antibiotic use data is the main theme. One study focuses on the importance of units of measurement for a meaningful understanding of trends in antibiotic use data with regards to antibiotic resistance risks. In another study the surveillance of antibiotic use in Dutch hospitals between 1997 and 2002 is described. The final study of this part of the thesis is devoted to the identification of determinants of antibiotic use in Dutch hospitals. In the second research project, the epidemiology of colonization and resistance dynamics during and after hospitalization is assessed to identify risk factors for resistance emergence and to determine the relevance of transmission from the community into the hospitals, and vice versa. Colonization and resistance dynamics of Enterobacteriaceae, P. aeruginosa and Enterococcus species were assessed in the intestinal and oropharyngeal microflora of patients admitted to intensive care units and general wards. In the last chapter, the main findings of the studies in this thesis are discussed and some methodological issues are considered that are relevant to several studies in this thesis.

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