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Anello P, Vianello S, Baldo V, Frasson E, Gallo U, Rampazzo R, Marchiori M, Carraro M, Marchiori S, Pigozzo M, Manfrin V, Mazzariol A, De Ambrosis P, Gentili D, Tonon M, Cazzaro R, Scroccaro G, Russo F, Mengato D. Antimicrobial Stewardship and Infection Prevention and Control in the Veneto Region, Northeastern Italy: Governance Models, Resources, and Key Challenges Across Hospital and Community Settings-Findings from the ARCO Project. Microorganisms 2025; 13:405. [PMID: 40005771 PMCID: PMC11858048 DOI: 10.3390/microorganisms13020405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 01/17/2025] [Accepted: 02/09/2025] [Indexed: 02/27/2025] Open
Abstract
Antimicrobial resistance represents a global health challenge, with Italy among the most affected countries in Europe. In response, the Veneto Region developed governance models to enhance antimicrobial stewardship (AMS) and infection prevention in both hospital and community settings. This study assessed the implementation of these models and explored strategies for improvement. A survey targeting hospital medical and district health management, hospital pharmacies, and primary care pharmaceutical departments was conducted to evaluate governance adherence, resource allocation, training, and reporting practices. Findings were analyzed by a focus group comprising regional experts, infectious disease specialists, microbiologists, and policymakers, which identified critical gaps and proposed actionable recommendations. Results revealed disparities in AMS implementation between hospital and community care, with key challenges including limited multidisciplinary collaboration, inconsistent resource distribution, and gaps in training. The focus group emphasized the need for stronger governance, standardized protocols, and improved communication to address these shortcomings. This study underscores significant gaps and opportunities within the Veneto Region's healthcare system and provides a framework for enhancing AMS and infection prevention strategies, bridging the divide between hospital and community care to combat antimicrobial resistance effectively.
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Affiliation(s)
- Paola Anello
- Hospital Medical Management, ULSS 2 Marca Trevigiana Health Authority, St. Valentino Hospital, Via Palmiro Togliatti, 1, 31044 Montebelluna Treviso, Italy; (P.A.); (E.F.)
| | - Stefano Vianello
- Directorate of Health and Social Services, ULSS 6 Euganea Health Authority, Via Enrico degli Scrovegni, 12, 35131 Padova, Italy;
| | - Vincenzo Baldo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy;
| | - Enrica Frasson
- Hospital Medical Management, ULSS 2 Marca Trevigiana Health Authority, St. Valentino Hospital, Via Palmiro Togliatti, 1, 31044 Montebelluna Treviso, Italy; (P.A.); (E.F.)
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy;
| | - Umberto Gallo
- Primary Care Pharmaceutical Departments, ULSS 6 Euganea Health Authority, Via Enrico degli Scrovegni, 12, 35131 Padova, Italy;
| | - Roberta Rampazzo
- Hospital Pharmacy, ULSS 5 Polesana Health Authority, St. Maria della Misericordia Hospital, Viale tre martiri, 89, 45100 Rovigo, Italy;
| | - Milvia Marchiori
- Hospital Medical Management, ULSS 6 Euganea Health Authority, Camposampiero Hospital, Via G. Ponzian, 1, 35012 Camposampiero, Italy; (M.M.); (M.C.)
| | - Mara Carraro
- Hospital Medical Management, ULSS 6 Euganea Health Authority, Camposampiero Hospital, Via G. Ponzian, 1, 35012 Camposampiero, Italy; (M.M.); (M.C.)
| | - Sara Marchiori
- Integrated Home Care Service, ULSS 3 Serenissima Health Authority, Via Don Federico Tosatto, 49, 30174 Venezia, Italy;
| | - Marta Pigozzo
- Hospital Medical Management, ULSS 3 Serenissima Health Authority, “Dell’Angelo” Hospital, Via Paccagnella, 11, 30174 Chirignago-Zelarino, Italy;
| | - Vinicio Manfrin
- Department of Infectious Diseases, St. Bortolo Hospital, Viale Ferdinando Rodolfi 37, 36100 Vicenza, Italy;
| | - Annarita Mazzariol
- Department of Diagnostics and Public Health, University of Verona, Strada le Grazie, 8, 37134 Verona, Italy;
| | - Paola De Ambrosis
- Regional Directorate for Pharmaceutical and Medical Devices, Rio Novo-Dorsoduro 3493, 30123 Venezia, Italy; (P.D.A.); (G.S.)
| | - Davide Gentili
- Regional Directorate for Prevention, Food Safety, Veterinary, Public Health-Veneto Region, Rio Novo-Dorsoduro 3493, 30123 Venezia, Italy; (D.G.); (M.T.); (F.R.)
| | - Michele Tonon
- Regional Directorate for Prevention, Food Safety, Veterinary, Public Health-Veneto Region, Rio Novo-Dorsoduro 3493, 30123 Venezia, Italy; (D.G.); (M.T.); (F.R.)
| | - Romina Cazzaro
- Regional Directorate for Health Programming, Rio Novo-Dorsoduro 3493, 30123 Venezia, Italy;
| | - Giovanna Scroccaro
- Regional Directorate for Pharmaceutical and Medical Devices, Rio Novo-Dorsoduro 3493, 30123 Venezia, Italy; (P.D.A.); (G.S.)
| | - Francesca Russo
- Regional Directorate for Prevention, Food Safety, Veterinary, Public Health-Veneto Region, Rio Novo-Dorsoduro 3493, 30123 Venezia, Italy; (D.G.); (M.T.); (F.R.)
| | - Daniele Mengato
- Hospital Pharmacy Department, Azienda Ospedale-Università Padova, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
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Fedeli U, Barbiellini Amidei C, Tacconelli E, Carrara E. Sepsis-related mortality: long-term trends in Northeastern Italy, including pandemic years. Infect Dis (Lond) 2024; 56:624-631. [PMID: 38607235 DOI: 10.1080/23744235.2024.2340728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Global estimates of sepsis mortality are based on multiple causes of death (MCOD, any mention of the condition on death certificates); however, MCOD data are sparse and mainly referring to the pre-pandemic period. OBJECTIVES To investigate recent trends in sepsis-related mortality, associated sites of infection, and comorbidities in Veneto (Northeastern Italy). METHODS Mortality records from 2008 to 2022 were extracted, and sepsis-related mortality was assessed based both on the underlying cause of death (UCOD) and on MCOD. The average annual percent change in age-standardised rates was estimated by join point regression through the whole study period. MCOD records were investigated to retrieve infection sites and comorbidities. RESULTS Sepsis was mentioned in 63,479 death certificates, growing from 4.9% out of all deaths in 2008 to 12.9% in 2022. Age-standardised mortality rates increased yearly by 8.2% (95%CI 2.1-14.7%) based on the UCOD and by 5.9% (95%CI 5.3-6.5%) based on MCOD. Sharp peaks in monthly mortality were observed in correspondence with flu epidemics, COVID-19 pandemic waves, and periods of extreme heat. The percentage of sepsis-related deaths associated to urinary tract infections, and with mention of neurodegenerative disorders and chronic kidney disease increased over time. CONCLUSION Raised awareness of physicians, ageing of the population, spread of antimicrobial resistance further fuelled by the COVID-19 pandemic are among reasons of increasing sepsis-related mortality in Italy. Continuous monitoring of sepsis by means of MCOD data and other surveillance tools is warranted.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Padova, Italy
| | | | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Elena Carrara
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
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