The impact of antimicrobial stewardship programs on the appropriateness of prophylaxis and antimicrobial therapy: the experience of the “F. Miulli” Hospital of Bari

Introduction: The continuous increase of antimicrobial resistance (AMR) requires antimicrobial stewardship programs (ASPs) to optimize antimicrobial use, including selection, dose, duration, and way of administration. Methods and Results: An “Antimicrobial Stewardship Team” (AST) was established at “F. Miulli” Hospital of Bari. The AST is a multidisciplinary group formed by a pharmacist, an infectious disease specialist, a microbiologist, an anesthetist and a hygienist. The AST has started a clinical path of professional interactions and optimization of antimicrobial use. The AST was focused on surgical antibiotic prophylaxis, planning events/meetings with 13 wards of “F. Miulli” hospital and writing 13 operating guidelines. The AST was focused on antimicrobial therapies too. On this occasion, the AST did not organize events or meetings but was focused on professional interactions with clinicians to optimize the antimicrobial use in the treatment of multi-drug resistant (MDR) pathogens. A reduction of antimicrobial use (defined daily dose, DDD) and pharmaceutical expenditure was reached in surgical wards during 2017-2018, while, in the same period, an increase of antimicrobial use (DDD) and pharmaceutical expenditure was observed in non-surgical wards. Conclusions: The “Antimicrobial Stewardship Team” programs are essential to monitor the hospital economic resources and to support the purchase of the innovative antimicrobial therapies to treat multi-drug resistant pathogens.