Quality indicators for appropriate inpatient antibiotic use: results from two national surveys in Italy, 2016-2022.

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2025-04-01 DOI:10.1016/j.jhin.2025.03.007

Costanza Vicentini, Antonino Russotto, Roberta Bussolino, Marta Castagnotto, Claudia Gastaldo, Stefano Bazzolo, Dario Gamba, Silvia Corcione, Francesco Giuseppe De Rosa, Fortunato D'Ancona, Carla Maria Zotti

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引用次数: 0

Abstract

Background: To address its high antimicrobial resistance (AMR) and antibiotic consumption rates, Italy introduced a national action plan to contrast AMR (PNCAR) in 2017.

Aim: To investigate trends in antibiotic use, prescribing practices, and AMR rates in Italy through indicators of appropriate antibiotic use.

Methods: Two point prevalence surveys (PPSs), according to ECDC methods and definitions, were conducted in 2016 and 2022. Indicators of appropriate antibiotic use were defined and measured. Antibiotic use prevalence and AMR rates for specific pathogen-drug combinations were calculated. To account for potential confounding factors, a propensity score matching approach was applied to compare the results of the two PPS editions using prevalence rate ratio (PRR).

Results: Overall, 28,991 patients from 140 hospitals and 60,403 patients from 325 hospitals were included in 2016 and 2022 respectively. Patient characteristics remained stable, but patients were increasingly exposed to invasive procedures. The overall prevalence of antibiotic use decreased from 43.51 to 41.52 (PRR 0.95, 95% confidence interval, CI 0.94 - 0.97, p <0.001). Improvements in some prescribing practices were identified: the proportion of surgical prophylaxis lasting >1 day decreased from 55.99% to 52.15%, (PRR 0.94, 95% CI 0.90 - 0.98, p <0.001) and the proportion of culture-guided hospital infection treatments increased from 33.68% to 48.57% (PRR 1.30, 95% CI 1.22 - 1.38, p<0.05). Conversely, a significant rise in the proportion of last line/broad spectrum agents was recorded for most indications.

Conclusion: This study provided a mapping of prescribing activity at national level, and defined measurable quality indicators, through which strengths and areas for improvement in prescribing practices were identified.

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.