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

Abstract

BackgroundAntimicrobial 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, Northern Italy. MethodsAMS programs were investigated via a survey addressing structure, process and outcome indicators. For outcome indicators, annual means for the years 2017-2019 were considered, as well as the percentage change between 2017 and 2019. Outcome indicators were investigated in relation to structure and process scores using Spearman correlation. ResultsIn 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 percentages 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 ρ -0.603, P .006 and ρ -0.433, P .044 respectively). DiscussionThis 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. ConclusionRepeated measurements of structure and process indicators will be important to guide continuing quality improvement efforts.