Implementation of A Year-Long Antimicrobial Stewardship Program in A 227-Bed Community Hospital in Southern Italy

Giuseppe Davide Albano (), Mauro Midiri, Stefania Zerbo (), Emanuele Matteini, Giulia Passavanti, Rosario Curcio, Lidia Curreri, Salvatore Albano, Antonina Argo and Marcello Cadelo
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Giuseppe Davide Albano: Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
Mauro Midiri: Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
Stefania Zerbo: Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
Emanuele Matteini: Fondazione Istituto G. Giglio, Contrada Pietra PollastraPisciotto, 90015 Cefalù, Italy
Giulia Passavanti: Fondazione Istituto G. Giglio, Contrada Pietra PollastraPisciotto, 90015 Cefalù, Italy
Rosario Curcio: Fondazione Istituto G. Giglio, Contrada Pietra PollastraPisciotto, 90015 Cefalù, Italy
Lidia Curreri: Fondazione Istituto G. Giglio, Contrada Pietra PollastraPisciotto, 90015 Cefalù, Italy
Salvatore Albano: Fondazione Istituto G. Giglio, Contrada Pietra PollastraPisciotto, 90015 Cefalù, Italy
Antonina Argo: Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
Marcello Cadelo: Fondazione Istituto G. Giglio, Contrada Pietra PollastraPisciotto, 90015 Cefalù, Italy

IJERPH, 2023, vol. 20, issue 2, 1-11

Abstract: Background: Healthcare-Acquired Infections (HAIs) are serious healthcare complications affecting hospital stay, in-hospital mortality, and costs. Root cause analysis has identified the inappropriate use of antibiotics as the main causative factor in the expansion of multi-drug-resistant organisms (MDRO) in our hospital. An Antimicrobial Stewardship (AMS) program was implemented to optimize antibiotic use, limit the development of resistance, improve therapeutic efficacy and clinical outcomes, and reduce costs. Methods: The stewardship strategies were: antimicrobial oversight on “critical” antibiotics; the development of hospital guidelines on antibiotic selection with the production of a consensus document; the implementation of clinical and management control algorithms with visual impact and Business Intelligence methods; training and updating; and the monitoring of outcome measures and process indicators. Results: Clinical outcomes: length of stay reduced by 0.23 days, hospital readmission/first month rates decreased by 19%, and mortality for infections reduced by 8.8%. Microbiological Outcomes: Clostridium Difficile colitis incidence reduced by 9.1%.Economic Outcomes: Reduction in antimicrobial costs by 35% on average fee/discharged patient. Conclusions: The systematic application of the AMS program in a small hospital led to multiple improvements in clinical, microbiological, and economic outcome measures. The analysis of the core indicators for our hospital AMS program showed a significant adherence to the model and hospital recommendations.

Keywords: healthcare-acquired infections (HAIs); multidrug-resistant organism (MDRO); antimicrobial stewardship (AMS); patient safety; medico-legal issues; responsibility; litigation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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