204 English summary English summary The increase of antimicrobial resistance (AMR) poses one of the greatest threats to global healthcare. AMR occurs when bacteria adapt and become insensitive to one or more antimicrobials, rendering them ineffective. The use of antimicrobials in many ways (human and veterinary medicine and xenobiotics) is the main cause of this increasing resistance. AMR makes treating patients with bacterial infections increasingly difficult and this may eventually even become impossible. The discovery of antimicrobials was a major medical breakthrough that made the treatment of bacterial infections possible. Before that discovery, mortality from bacterial infections was high. In primary care practice and hospitals, antimicrobial prescription is now an indispensable daily medical routine. General practitioners (GP) can relatively easy, effectively and safely treat patients with potentially life-threatening bacterial infections, such as pneumonia or complicated urinary tract infections. In the hospital, antimicrobials are part of many treatments or prophylactic regimens, for example to prevent wound infection after surgery. The "One-health" approach is often used in the context of AMR. In this approach, the basic premise is that the health of humans, domestic and wild animals, plants and the wider environment (including ecosystems) are closely connected and interdependent. Antimicrobial selection pressure is part of the process that leads to AMR and is defined as the extent to which antimicrobial use enhances the selection process that increases the growth of resistant micro-organisms. From the One Health perspective, antimicrobial use from all domains (hospital care, veterinary medicine, primary care practice and industrial use) contributes to antimicrobial selection pressure, regardless of the specific domain where the antimicrobial is used. Currently, most bacterial infections in the Netherlands can still be treated well with a targeted, narrow-spectrum antimicrobial. These antimicrobials are effective against a limited number of types of common bacteria and, if properly indicated, carry a low risk to induct resistance. However, the use of narrow-spectrum antimicrobials alone is so high that it leads to substantial antimicrobial selection pressure and consequently to an increase in AMR. This results in more frequent use of broadspectrum antimicrobials. These are antimicrobials effective against multiple types of bacteria and often against more resistant bacteria. Broad-spectrum antimicrobials have the general disadvantage that their use carries a greater risk of developing AMR than narrow-spectrum antimicrobials. This negative spiral can eventually lead to increased prescribing of broad-spectrum antibiotics by physicians. As they will
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