TY  -  JOUR
AU  -  Roncarati, Greta
AU  -  Castelvetri, Cristina
AU  -  Di Giulio, Rosella
AU  -  Mazzetti, Magda
AU  -  Guerra, Luca
AU  -  Farruggia, Patrizia
T1  -  Stewardship antibiotica: 
il programma dell’Azienda USL Bologna
PY  -  2014
Y1  -  2014-01-01
DO  -  10.1716/1422.15746
JO  -  GIMPIOS
JA  -  Gimpios
VL  -  4
IS  -  1
SP  -  32
EP  -  38
PB  -  Il Pensiero Scientifico Editore
SN  -  1122-407X
Y2  -  2026/04/20
UR  -  http://dx.doi.org/10.1716/1422.15746
N2  -  Aims. In the USL (AUSL) of Bologna (9 Hospitals and 1 IRCSS for a total of approximately 1.600 beds) starting from 2010 is active an antibiotic stewardship program to reduce the inappropriate use of antibiotics and control the phenomenon of antibiotic resistance. Methods. The CIO of the USL Bologna has defined the individual actions of its stewardship program; the composition of the multi-professional-disciplinary working group, the responsible for the program, the indicators of antibiotic costs and consumption and outcome by which to monitor it. It has been monitored the progress of the specific MDRO’s incidence. Business protocols were drawn up on the treatment of: urinary tract infection (UTI), pneumonia and Clostridium difficile infections. Two separate audits were activated about requested fluoroquinolone therapies and about perioperative prophylaxis for the appropriate prescription evaluation. It has been proposed a method of early revision of antibiotic therapy, which were carried out preliminary surveys on the extent of adherence by measuring the point prevalence of the use of antibiotics in the medical units. Results. In 2012, spending on antibiotics was € 1.363.000 (down 49% compared to 2011). The consumption in the Departments of Hospital rose from 107.1 defined daily dose/ 100 days of hospitalization (days DDD/100 Deg) in 2011 to 100.8 in the 9 months 2012. The consumption of fluoroquinolones in the Medical Department was reduced by 24%. The performance of multiresistenze noted a decline in isolations of methicillin resistant Staphylococcus aureus in blood cultures in the medical area: year 2011 vs. year 2012-14%. The positivity for C. difficile, have decreased compared to 2010, with a decline of outbreaks (epidemics 9 C. difficile/16 total epidemics in 2010 vs. 4 C. difficile outbreaks/9 total epidemics in 2011 vs. 1 C. difficile outbreaks/9 total epidemics in 2012). The audit on fluoroquinolones (FC) has shown that the majority of prescription FC in the hospital AUSL is attributable to the treatment of pulmonary infections (57%). In 37 % of cases at the base of the prescription was present investigation culture: urine cultures carried out in 24% and 13% in blood cultures. The degree of adherence to the guidelines of the company protocol for the treatment of urinary tract infections was equal to 44 % of cases. From the measurements of prevalence is also found that the antibiotic prescription in July 2012 was present in 33% of cases hospitalized, down from the previous survey conducted in July 2010 (44%), and that this requirement was a result of a diagnosis of infection in the 86% of cases. Conclusions. Despite the first period of clinical observation consequent activation of the program is relatively short, at least as regards the outcome multiresistenze, the results show an overall decrease in the first given consumption category and multiresistenze antibiotics (MRSA) in some areas. The consumption of fluoroquinolones has decreased. Also changed the given category of expenditure and consumption of fluoroquinolones.
ER  -