Antimicrobial stewardship experiences in acute-care hospitals of Northern Italy: Assessment of structure, process and outcome indicators, 2017-2019

Background: Antimicrobial stewardship (AMS) programs are effective strategies for optimizing antimicrobial use. We aimed to assess AMS programs implemented in acute-care trusts of the region of Piedmont, North-ern Italy.Methods: AMS programs were investigated via a survey addressing structure, process and outcome indica-tors. For outcome indicators, annual means for the years 2017-2019 were considered, as well as the percent-age change between 2017 and 2019. Outcome indicators were investigated in relation to structure and process scores using Spearman correlation.Results: In total, 25 AMS programs were surveyed. Higher scores were achieved for process over structure indicators. Improvements in alcohol-based handrub usage (+30%), total antimicrobial usage (-4%), and per-centages of methicillin-resistant Staphylococcus aureus and carbapenem-resistant Enterobacteriaceae over invasive isolates (respectively-16 and-23%) were found between 2017 and 2019. Significant correlations were found between structure score and percentage change in total antimicrobial usage and carbapenem-resistant Enterobacteriaceae over invasive isolates (Spearman's r-0.603, P .006 and r-0.433, P .044 respectively). Discussion: This study identified areas for improvement: accountability, microbiological laboratory quality management and feedback to clinicians. Improving the organization of AMS programs in particular should be prioritized.Conclusion: Repeated measurements of structure and process indicators will be important to guide continu-ing quality improvement efforts.(c) 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Automated summary

This study investigated antimicrobial stewardship (AMS) programs in acute-care trusts in Piedmont, Northern Italy, and evaluated the structure, process, and outcome indicators. The study found improvements in antimicrobial usage, methicillin-resistant Staphylococcus aureus, and carbapenem-resistant Enterobacteriaceae between 2017 and 2019. Significant correlations were found between structure indicators and changes in antimicrobial usage and carbapenem-resistant Enterobacteriaceae.