SPiNCAR: A systematic model to evaluate and guide actions for tackling AMR.

Giulia Bravo,Antonella Agodi,Gianluca Cavallaro,Giuseppe Diegoli,Patrizio Pezzotti,Matteo Marrazzo,Ornella Punzo,Antonino Bella,Giovanni Loris Alborali,Annalisa Pantosti,Laura Brunelli,Elena Mazzolini,Adriano Grossi,Luca Arnoldo,Martina Barchitta,Greta Castellini,Maria Luisa Moro,Silvio Brusaferro,F Malacarne ,Carla Maria Zotti ,F Auxilia ,P Tricarico ,G Cattani

doi:10.1371/journal.pone.0265010

Abstract

BackgroundItaly records very alarming levels antimicrobial resistance (AMR), so a National Action Plan on Antimicrobial resistance (PNCAR) was developed, adopting the AMR European Union’s recommendations based on the results of the ECDC site visit of January 2017. For achieving PNCAR objectives, it is necessary to support and harmonize the implementation of recommendations in all the different healthcare levels (regional authorities and local trusts), so the SPiNCAR project was launched to create a tool for reaching this goal.MethodsWe developed a framework based on a scientific literature and national and international guidelines. Firstly, we identified the major intervention areas for tackling AMR, then, for each area, we built a set of standards, both for regional authorities than for local trusts. Every standard is composed by a set of essential and additional criteria, which refer to a minimum or supplemental performance level respectively. The contents were firstly discussed by the project’s team during face-to-face kick-off meetings, then confirmed with Delphi methodology and finally validated through a pilot study.ResultsThe final framework consists of seven different areas that reflect the PNCAR structure: Governance, Surveillance and Monitoring, Appropriate Use of antimicrobials, Healthcare-associated Infections (HAIs) control and prevention, Education and Training, Alliance among Stakeholders, Implementation. The total number of standards for the regional framework was 34 with 264 criteria and for the local version 36 criteria with 279 standards.ConclusionThe ongoing use of this tool, developed on international evidences and recommendations that were tailored on the Italian specific context, allows monitoring the improvement achieved over time and plan the next steps.

Highlights

The most important national and international institutions recognize the increase of antimicrobial resistance (AMR) as a global threat [1–3]
The final framework consists of seven different areas that reflect the Plan on Antimicrobial resistance (PNCAR) structure: Governance, Surveillance and Monitoring, Appropriate Use of antimicrobials, Healthcare
Data reported from the most recent surveys conducted by the European Centre for Disease Prevention and Control (ECDC) show that in acute Italian hospitals over 40% [4] of the patients are in treatment or prophylaxis with at least one antimicrobial agent, while in the long-term care facilities (LTCFs) the prevalence of residents with antimicrobial prescription was 5.5% [5]

Summary

Introduction

The most important national and international institutions recognize the increase of antimicrobial resistance (AMR) as a global threat [1–3]. Data related to the local primary care facilities and the residential and semi-residential structures would not be less worrying considering results of the annual report on drugs consumption published by the Italian Drugs Agency (AIFA) (OsMed Report) [6], where antimicrobials have been confirmed among the first categories of drugs for overall consumption This situation worsened due to the massive antibiotics use in the livestock and agricultural sectors, with Italy ranking among the top countries of the European Union both for antimicrobial consumption and AMR levels [7–9]. These findings are even more alarming if we consider the current epidemiological prediction for 2,050 of about 10 million deaths attributable to infections caused by resistant microorganisms worldwide [14] To properly contrast this evolution, the adoption of structured and integrated programs on AMR is recommended by the scientific literature and both national and international institutions [2, 15–17] and reiterated by the European Council in the “Council Conclusions on the steps under a One Health approach to combat antimicrobial resistance” document [18]. For achieving PNCAR objectives, it is necessary to support and harmonize the implementation of recommendations in all the different healthcare levels (regional authorities and local trusts), so the SPiNCAR project was launched to create a tool for reaching this goal

Methods

Results

Discussion

Conclusion