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


      • We assessed AMS programs of acute-care trusts of the region of Piedmont, Italy.
      • All trusts implemented AMS, with varying levels of organization and delivery.
      • Higher scores were found for process vs. structure indicators.
      • Outcome indicator results suggest improvements in quality of care.
      • A significant correlation between AMS structure and improved outcomes was found.



      . 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, Northern Italy.


      . AMS 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.


      . 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 percentages of MRSA and carbapenem-resistant Enterobacteriaceae (CRE) 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 CRE over invasive isolates (Spearman's ρ -0.603, p 0.006 and ρ -0.433, p 0.044 respectively).


      . 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.


      . Repeated measurements of structure and process indicators will be important to guide continuing quality improvement efforts.


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