KEY POINTS 2021 National surveillance of antibiotic resistance in community and healthcare settings relies on a broad network of community clinical laboratories (LBMs) that voluntarily participate in the surveillance program. 1,564 CLBs from the 13 regions of mainland France, as well as the islands of Guadeloupe and Martinique, participated in the Primo surveillance program in 2021, and 260 healthcare facilities (HCFs) with long-term care units participated in the Spares surveillance program (Table 1). In 2021, 715,938 antibiotic susceptibility tests performed on Enterobacteriaceae isolated from urine samples were collected (85.9% Escherichia coli and 9.3% Klebsiella pneumoniae). Resistance observed in Escherichia coli (urinary), home-bound patients (Table 2): - Resistance to C3G by ESBL: 2.8% (Map 1) - Resistance to FQ: 12.7% (Map 2) - Number of carbapenemase-producing strains: 52 Resistance observed in Escherichia coli (urinary), nursing home residents (Table 3): - Resistance to C3G by ESBL: 8.4% (Map 1) - Resistance to FQ: 19.5% (Map 2) - Number of carbapenemase-producing strains: 3 Stability in the proportion of ESBL-producing E. coli strains since 2017 among patients living at home as well as in nursing homes (Figure 1a). Increase in the proportion of FQ-resistant E. coli strains since 2017 among patients living at home and stabilization among nursing home residents (Figure 1b). Resistance observed in K. pneumoniae (urinary), patients at home (Table 4): - Resistance to C3G by ESBL: 8.3% (Map 3) - Resistance to fluoroquinolones: 12.5% (Map 4) - Number of carbapenemase-producing strains: 51 Resistance observed in K. pneumoniae (urinary tract), nursing home residents (Table 5): - Resistance to C3G via ESBL: 18.6% (Map 3) - Resistance to fluoroquinolones (FQ): 23.3% (Map 4) - Number of carbapenemase-producing strains: 3 In conclusion, the Primo surveillance program relies on an ever-expanding network of volunteer community laboratories and enables the description of bacterial ecology in urban areas and long-term care facilities, where 92% of antibiotics are consumed. In addition to antibiotic consumption, social and environmental determinants may explain the observed regional variations [1, 2]. Resistance rates are consistently higher in healthcare facilities than in the community, regardless of the indicator. The decrease in the proportion of urinary E. coli strains producing ESBL among patients living at home and residents in nursing homes between 2020 and 2021 coincides with the implementation of measures to combat the COVID-19 pandemic [3]. Nevertheless, it is difficult to establish causality, and these trends will need to be confirmed in 2022.