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

Background: 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, North-ern Italy.Methods: AMS programs were investigated via a survey addressing structure, process and outcome indica-tors. For outcome indicators, annual means for the years 2017-2019 were considered, as well as the percent-age change between 2017 and 2019. Outcome indicators were investigated in relation to structure and process scores using Spearman correlation.Results: 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 per-centages 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 r-0.603, P .006 and r-0.433, P .044 respectively). Discussion: 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.Conclusion: Repeated measurements of structure and process indicators will be important to guide continu-ing quality improvement efforts.(c) 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.