The role of a Local Health Unit in fighting antimicrobial resistance: the experience of ASL TO3 in Piedmont, Italy
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University of Turin Department of Public Health Sciences and Pediatrics Italy
Local Health Unit TO3 Local Health Unit TO3 Italy
University of Turin Department of Public Health Sciences and Pediatrics; A. O. U. City of Health and Science of Turin Italy
University of Turin Department of Public Health Sciences and Pediatrics; Local Health Unit TO3 Italy
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A121
Background and Objective:
Antimicrobial Resistance (AMR) represents a global health threat which, as reported by recent analyses, could cause 10 million deaths/year by 2050. According to international guidelines, a dedicated Antimicrobial Stewardship (AMS) team was implemented in asl to3, a local health unit in piedmont, in order to process data and to improve good practices related to responsible antibiotic use. The aim of this study is to evaluate the Carbapenem-Resistant Enterobacteriaceae (CRE) 5-years trend in asl to3 as an indicator of ams strategies implemented.

CRE laboratory data were extracted through the virtuoso platform. redundancies were eliminated within 28 days, but any “duplicates” per material and any “multiple isolations” were retained. The analysis included stratification by pathogen, E. Coli (EC) and Klebsiella Pneumoniae (KP), and by presence or absence of resistance.

AMS included strategies such as data collection and analysis about antibiotics prescriptions and microbiological tests, medical health records audit and meetings with clinicians. Despite a 9% increase in microbiological testing, an overall decrease in total and stratified cre from 2017 to 2021 was recorded. Total CRE dropped from 222/7368 (3.01%) to 136/8054 (1.68%), KP carbapenem-resistant from 18.86% to 11.74% and EC carbapenem-resistant from 0.71% to 0.09%. Almost all of the CRE bacteremia diagnosed in 2021 was caused by KP (95.6%), and only a small portion by EC (4.4%).

Since the implementation of an ams program, data related to cre infections has been continuously improving and are currently lower than regional and national trends. A decrease in antimicrobial-resistant microorganisms infections can result in reduced mortality and cost of care. A constructive comparison of the action of several health care settings in the field of ams can be a weapon in the global fight against amr.