Impact of a structured antimicrobial stewardship program in Cittadella Hospital, Padua, Italy
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Azienda ULSS 6 Euganea, Hospital Direction, Cittadella Hospital, ULSS 6 Euganea, Via Casa di Ricovero 40, Cittadella, Italy
Azienda ULSS 6 Euganea
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A143
Background and Objective:
Cittadella Hospital (Padua) has 400 beds and serves a territory of 240,000 inhabitants. Regarding antimicrobial stewardship program, special focus was put on fluoroquinolones, carbapenem and third generation cephalosporins. A reduction > 5% of fluoroquinolones use was directly demanded by the Italian National Action Plan against antimicrobial resistance; third generation cephalosporins are some of the most prescribed antibiotics in the hospital settings.

Appropriate use of antibiotics was encouraged during periodic multidisciplinary meetings held by the Hospital Infection Control Committee (made up of Hospital Antimicrobial Stewardship Task Force, Infectious Disease Consultant, Microbiologist, Pharmacist etc.).

The Pharmaceutical Service provided a quantitative estimate of antibiotic consumption, expressed in Defined Daily Dose (DDD) per 100 bed-days. Between 2019 and 2022, a large decrease in the consumption of carbapenems in Intensive Care Unit (from 15.3 to 15.2 DDD, - 0.6%) and in Medical wards (from 6.2 to 3.1 DDD, - 50.0%) was reported; a decrease in the consumption of quinolones in Intensive Care Unit (from 22.4 to 13.0 DDD, - 41.9%), Medical wards (from 11.9 to 7.3 DDD, - 38.6%) and Surgical wards (from 12.0 to 7.6 DDD, - 36.6%) was highlighted; a small decline in the consumption of third generation cephalosporins in Medical wards (from 17.4 to 17.2 DDD, - 1.1%) was reported. Finally, a decrease in the consumption of macrolides was reported in the Intensive Care Unit (from 9.7 to 3.1) and Medical wards (from 9.0 to 8.9).

Periodic multidisciplinary meetings aimed at medical referrals for infections, constant monitoring of antimicrobial consumption and timely identifying of warning situations that may need a specific intervention are the cornerstone of Antimicrobial Stewardship programs, together with analyzing data of bacterial resistance rates and infections from multi-drug resistant bacteria.