Department of Public Health and Paediatrics, University of Turin, Turin, Italy.
Department of Public Health and Paediatrics, University of Turin, Turin, Italy.
Am J Infect Control. 2023 Mar;51(3):282-288. doi: 10.1016/j.ajic.2022.06.006. Epub 2022 Jun 13.
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 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 ρ -0.603, P .006 and ρ -0.433, P .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.
抗菌药物管理（AMS）计划是优化抗菌药物使用的有效策略。我们旨在评估意大利北部皮埃蒙特大区急性护理信托机构实施的 AMS 计划。
通过一项针对结构、过程和结果指标的调查来调查 AMS 计划。对于结果指标，考虑了 2017-2019 年的年度平均值，以及 2017 年至 2019 年的百分比变化。使用 Spearman 相关性分析结果指标与结构和过程评分之间的关系。
共调查了 25 个 AMS 计划。过程指标的得分高于结构指标。2017 年至 2019 年间，酒精基洗手液使用率（+30%）、总抗菌药物使用率（-4%）以及耐甲氧西林金黄色葡萄球菌和耐碳青霉烯肠杆菌科菌在侵袭性分离株中的比例（分别为-16%和-23%）有所改善。结构评分与总抗菌药物使用率和耐碳青霉烯肠杆菌科菌在侵袭性分离株中的百分比变化之间存在显著相关性（Spearman's ρ 分别为-0.603，P.006 和 ρ -0.433，P.044）。
本研究确定了需要改进的领域：问责制、微生物实验室质量管理和向临床医生提供反馈。应优先考虑改善 AMS 计划的组织。
重复测量结构和过程指标对于指导持续质量改进工作非常重要。
