In-hospital antibiotic consumption in Lombardy, Italy (2017-2024): a retrospective analysis of regional administrative data.

Authors

Matteo Augello, Massimo Cartabia, Marina Azab, Camilla Tincati, Danilo Cereda, Olivia Leoni, Ida Fortino, Davide Mangioni, Giulia Renisi, Massimo Puoti, Pierluigi Plebani, Andrea Gori, Mauro Tettamanti, Alessandro Nobili, Alessandra Bandera, Giulia Marchetti

Published in

The Journal of antimicrobial chemotherapy. Volume 81. Issue 10. Sep 01, 2026.

Abstract

Antimicrobial stewardship (AMS) is essential to tackle antimicrobial resistance. Antibiotic consumption (AC) surveillance provides evidence to guide AMS interventions. This study investigated in-hospital AC trends in Lombardy, Italy (2017-2024), with particular focus on the impact of COVID-19.
AC was expressed as DDDs per 100 bed days (absolute AC), relative proportions of Access/Watch/Reserve antibiotics (relative AC), Access-to-Watch index, and Access-to-(Watch + Reserve) index. Analyses were stratified by ward type-medical (MUs), surgical (SUs), and intensive care units (ICUs)-and timeframes: pre-COVID-19 (01/2017-02/2020), COVID-19 onset (02-03/2020), COVID-19 (03/2020-05/2023), and post-COVID-19 (05/2023-12/2024).
Despite a surge in total AC in 2017-2024, relative Access AC rose while relative Watch AC declined, resulting in an increase of the Access-to-Watch and Access-to-(Watch + Reserve) indexes, except in ICUs. A transient reversal of such favourable trends was observed at COVID-19 onset. Nevertheless, the WHO 2023 target of ≥60% total AC being Access was not achieved; furthermore, Access-to-Watch and Access-to-(Watch + Reserve) indexes constantly remained <1, except for SUs. A downward trend in Access-to-Watch and Access-to-(Watch + Reserve) indexes was registered in the post-pandemic period. Reserve AC increased across time, periods and wards, exceeding the expected levels obtained using projections from pre-COVID-19 data.
These findings highlight substantial shifts in in-hospital AC in Lombardy during the period 2017-2024, with concerning increases in Reserve antibiotics and an enduring failure to meet the 2023 WHO target of ≥60% Access antibiotics especially in MUs and ICUs, underscoring the need for reinforced AMS policies in the post-pandemic era.

PMID:
42702569
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.

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