Antibiotic misuse and overuse are important contributors to the development of antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) programs are coordinated sets of actions aiming to promote appropriate antibiotic use, improving patient outcomes whilst reducing AMR. Two main organizational models for AMS programs have been described: restrictive strategies (RS) vs. enabling strategies (ES). Evaluating and understanding social and cultural influences on antibiotic decision-making are critical for the development of successful and sustainable context-specific AMS programs. Characteristics and surrogate outcomes of AMS programs operating in acute-care hospitals of Piedmont in north-western Italy were investigated. The aim of this study was assessing whether RS vs. ES operating in our context were associated with different outcomes in terms of total antimicrobial usage and percentage of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant enterobacteria (CRE) over invasive isolates. In total, 24 AMS programs were assessed. ES were more frequently chosen compared to RS, with the latter being implemented only in broader AMS programs involving enabling components (combined strategy, CS). This study found no difference in evaluated outcomes among hospitals implementing ES vs. CS, suggesting both approaches could be equally valid in our context.

中文翻译：

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根据文化背景定制抗菌药物管理 (AMS) 干预措施：对在意大利北部急救医院开展的 AMS 项目的调查

抗生素滥用和过度使用是导致抗生素耐药性 (AMR) 发展的重要因素。抗菌药物管理 (AMS) 计划是一系列协调一致的行动，旨在促进适当的抗生素使用，改善患者预后，同时降低 AMR。已经描述了 AMS 计划的两种主要组织模型：限制性策略 (RS) 与支持性策略 (ES)。评估和理解社会和文化对抗生素决策的影响对于开发成功和可持续的特定环境 AMS 计划至关重要。调查了在意大利西北部皮埃蒙特急症医院开展的 AMS 项目的特征和替代结果。本研究的目的是评估 RS 与否。金黄色葡萄球菌(MRSA) 和耐碳青霉烯肠杆菌 (CRE) 超过侵入性分离株。总共评估了 24 个 AMS 计划。与 RS 相比，ES 被更频繁地选择，后者仅在涉及使能组件（组合策略，CS）的更广泛的 AMS 计划中实施。本研究发现实施 ES 与 CS 的医院之间的评估结果没有差异，这表明这两种方法在我们的环境中可能同样有效。