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

Vicentini, Costanza; Blengini, Valentina; Libero, Giulia; Raso, Roberto; Zotti, Carla Maria

doi:10.1016/j.ajic.2022.06.006

Cited by 5 publications

(8 citation statements)

References 19 publications

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“…Our previous analysis of data reported through the regional program found AMS interventions were implemented in all trusts, albeit with important inter-facility differences. Improvements in several outcome metrics were found: total antimicrobial usage decreased by 4% between 2017 and 2019, while AMR rates decreased by 16% and 23%, respectively, for the percentage of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant enterobacteria (CRE) over invasive isolates [ 19 ]. According to our survey, enabling strategies were implemented more frequently compared to restrictive strategies, however we did not investigate the impact of choice of strategy on outcome metrics in our previous publication [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

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Tailoring Antimicrobial Stewardship (AMS) Interventions to the Cultural Context: An Investigation of AMS Programs Operating in Northern Italian Acute-Care Hospitals

et al. 2022

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Antibiotic misuse and overuse are important contributors to the development of antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) programs are coordinated sets of actions aiming to promote appropriate antibiotic use, improving patient outcomes whilst reducing AMR. Two main organizational models for AMS programs have been described: restrictive strategies (RS) vs. enabling strategies (ES). Evaluating and understanding social and cultural influences on antibiotic decision-making are critical for the development of successful and sustainable context-specific AMS programs. Characteristics and surrogate outcomes of AMS programs operating in acute-care hospitals of Piedmont in north-western Italy were investigated. The aim of this study was assessing whether RS vs. ES operating in our context were associated with different outcomes in terms of total antimicrobial usage and percentage of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant enterobacteria (CRE) over invasive isolates. In total, 24 AMS programs were assessed. ES were more frequently chosen compared to RS, with the latter being implemented only in broader AMS programs involving enabling components (combined strategy, CS). This study found no difference in evaluated outcomes among hospitals implementing ES vs. CS, suggesting both approaches could be equally valid in our context.

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Section: Resultsmentioning

confidence: 99%

“…The methodology for data collection and applied definitions were described at length in our previous publication [ 19 ]. Briefly, AMS programs implemented in public and private trusts of Piedmont were investigated through a survey part of the regional HAI and AMR prevention and control program.…”

Section: Resultsmentioning

confidence: 99%

Tailoring Antimicrobial Stewardship (AMS) Interventions to the Cultural Context: An Investigation of AMS Programs Operating in Northern Italian Acute-Care Hospitals

et al. 2022

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“…Antimicrobial resistance (AMR) is one of the world’s major challenges in terms of global health, food safety, environmental wellbeing and socio-economic development, presenting a gradual increase on all continents ( WHO, 2019 ). AMR is considered a major public health threat contributing to elevated morbidity, mortality, prolonged hospital stays and significantly increased hospital costs ( O’Riordan et al, 2021 ; Vicentini et al, 2023 ).…”

Section: Introductionmentioning

confidence: 99%

“…Inappropriate or excessive use of antimicrobials are important determinants of AMR due to the ecological impact of these agents ( Vicentini et al, 2023 ). Previous estimates reported that 25%–50% of hospitalized patients use antibiotics, of which 20%–50% are unnecessary or inappropriate ( Kallen et al, 2019 ; van den Bosch et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

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Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective

et al. 2023

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Introduction: Antimicrobial resistance (AMR) is increasing and represents one of the world’s major challenges. AMR increase morbimortality, length of hospital stay and costs. Antimicrobial Stewardship Programs (ASP) are one of the key strategies to promote the rational use of antimicrobials since AMR is mostly driven by antimicrobial consumption.Objective: To describe the ASP implementation in a teaching hospital from the perspective of Donabedian quality assessment and the Brazilian regulatory requirements.Method: This was a descriptive study with secondary data collection, including document review of the ASP. The study setting was a general public 392-bed hospital. The ASP activities were performed by the hospital infection control committee (HICC), hospital pharmacy (HP) and diagnostic support laboratory (DSL). The description of the three services mainly involved in the ASP was based on a quality assessment model involving the dimensions of “structure”, “process” and “result” proposed by Donabedian. The distribution among dimensions was guided by the checklist of essential elements of the ASP that compose the Brazilian regulatory requirements. The checklist was applied in July, 2022, and the ASP results described from 2016 to 2021.Results: ASP actions have been gradually implemented since 2008 with the implementation of HICC and improved over the years. Regarding structure, the investments in technology were mapped, quantifying 26 computers and three software programs employed to computerize the ASP processes performed in specific physical areas by HICC, HP and DSL. Institutional guidelines used by HICC, HP and DSL guided clinical practices to operationalize ASP. The evaluation metrics improved for 10 indicators and worsened for four indicators. From the 60 items composing the checklist, the hospital met the requirements in 73.3% of the items (n = 44).Conclusion: This study described the implementation of ASP in a teaching hospital, applying the Donabedian perspective. Although the hospital still does not have a classic ASP model, there were investments to improve structure, processes and results, aiming to comply with international guidelines. A high proportion of key elements of ASP in the hospital were followed according to the Brazilian regulatory requirements. Aspects related to antimicrobial consumption and the emergence of microbial resistance deserve further investigations.

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Antimicrobial stewardship programs in acute-care hospitals: A multicenter assessment of structure, process, and outcome indicators in Italy and Spain

Lo Moro,

Marengo,

Mara

et al. 2024

Journal of Infection and Public Health

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

Cited by 5 publications

References 19 publications

Tailoring Antimicrobial Stewardship (AMS) Interventions to the Cultural Context: An Investigation of AMS Programs Operating in Northern Italian Acute-Care Hospitals

Tailoring Antimicrobial Stewardship (AMS) Interventions to the Cultural Context: An Investigation of AMS Programs Operating in Northern Italian Acute-Care Hospitals

Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective

Antimicrobial stewardship programs in acute-care hospitals: A multicenter assessment of structure, process, and outcome indicators in Italy and Spain

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