Trends in antibiotic consumption in an Italian hospital (2021-2024): evaluation based on the indicators of the National Plan for the Prevention of Antimicrobial Resistance (PNCAR)

BACKGROUND: Antimicrobial resistance (AMR) is a major global public health challenge, particularly in Italy, where surveillance data show high resistance rates for several pathogen-antibiotic combinations. This study aimed to evaluate trends in systemic antibiotic consumption in hospital settings within a Local Health Authority in Emilia-Romagna using PNCAR indicators. MATERIALS AND METHODS: A retrospective analysis of systemic antibiotic consumption (Anatomical Therapeutic Chemical Classification System - ATC, class J01) was conducted at the Piacenza Local Health Authority between 2021 and 2024, using the WHO AWaRe classification. Data were expressed as DDD and DDD per 100 bed-days across seven hospital departments. The European Surveillance of Antimicrobial Consumption (ESAC) indicator for broad-spectrum antibiotics was calculated. An economic analysis of antibiotic expenditure per inpatient day was also performed and compared with regional and national benchmarks. RESULTS: The hospital antibiotic consumption (ATC J01) showed an overall decline, decreasing from 113.3 DDD/100 bed-days in 2022 to 97.5 in 2024. AWaRe analysis revealed a marked reduction in Access antibiotics and a concomitant increase in Watch agents, while Reserve use remained stable. Amoxicillin-clavulanic acid and ceftriaxone were the most frequently prescribed antibiotics. The ESAC indicator remained stable at approximately 54%. CONCLUSIONS: Contextualizing antibiotic consumption data within local epidemiology allows a more accurate interpretation of prescribing patterns and supports the development of tailored stewardship interventions. Integrating local monitoring with national surveillance systems could strengthen the evaluation of PNCAR targets.