Point prevalence data on antimicrobial usage in Italian acute-care hospitals: Evaluation and comparison of results from two national surveys (2011-2016)

Objectives and design: Data from the Italian national point-prevalence survey (PPS) of healthcare-associated infections (HAIs) were used to evaluate antimicrobial usage (AMU) in Italy and to identify targets for future interventions. Methods: The second Italian PPS was conducted in 2016 as part of the European PPS initiated by the ECDC. We compared these results with those of the first national survey, conducted in 2011. Results: An overall AMU prevalence of 44.5% (95% CI, 43.7-45.3) was estimated in 2016. No significant change in AMU prevalence was detected when comparing data with the first survey. In both surveys, the most prevalent indication for AMU was the treatment of infections. Considering all indications, penicillins plus beta-lactamase inhibitors (BLIs) were the most commonly prescribed antimicrobial group in 2016; they were used significantly more than in 2011, and piperacillin plus BLI was the most frequently used agent. Broad-spectrum agents accounted for >60% of all antimicrobials for systemic use. No significant increase in the use of carbapenems occurred in 2016. Stable or decreasing carbapenem-resistance levels were identified in this study, although these levels remain alarmingly high for both Klebsiella pneumoniae (50%) and Acinetobacter baumannii (>75%). Conclusions: These results can be used to identify priorities and targets for interventions that promote more prudent use of antimicrobials, improve healthcare quality and patient safety, and combat the emergence and spread of antimicrobial-resistant pathogens.