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Antibiotics
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Antibiotic Stewardship Implementation Strategies
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Antibiotic Stewardship Implementation Strategies

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 827

Special Issue Editor

Dr. Massimo Sartelli

E-Mail Website
Guest Editor
Department of General and Emergency Surgery, Macerata Hospital, 62100 Macerata, Italy
Interests: surgical infections; intra-abdominal infections; healthcare-associated infections; sepsis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Since the discovery of penicillin in the late 1920s, antibiotics have saved the lives of millions of people. The capacity of healthcare systems to ensure patient safety is strictly based on access to effective antibiotics, both for preventing and treating infections. However, despite their essential benefits, antibiotics are often used inappropriately, posing a potential challenge in hospital settings.

Antibiotic stewardship can optimize antibiotic treatment and reduce adverse events associated with antibiotics. Evidence has demonstrated that antimicrobial stewardship can significantly reduce infections and colonization with multidrug-resistant bacteria and Clostridioides difficile in hospital settings. Therefore, hospitals worldwide should utilize the existing resources to organize an effective interdisciplinary team.

Antimicrobial stewardship programs (ASPs) have emerged as a key initiative aimed at optimizing antibiotic usage, improving patient outcomes, and mitigating the emergence of antimicrobial resistance. Fifteen years after the joint guidelines for developing institutional ASPs were devised, best practices are still poorly defined and can vary based on local practice patterns and the available resources.

This Special Issue aims to evaluate how these programs can be implemented in hospital settings.

Dr. Massimo Sartelli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antibiotic stewardship
  • implementation
  • hospital settings

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Published Papers (4 papers)

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Research

21 pages, 3409 KiB  
Article
Mapping the AMR Infection Landscape in Bihar: Implications for Strengthening Policy and Clinical Practice
by Vinay Modgil, Sundeep Sahay, Neelam Taneja, Burhanuddin Qayyumi, Ravikant Singh, Arunima Mukherjee, Bibekananda Bhoi and Gitika Arora
Antibiotics 2025, 14(7), 684; https://doi.org/10.3390/antibiotics14070684 - 5 Jul 2025
Viewed by 39
Abstract
Background: Antimicrobial resistance (AMR) poses a significant threat to public health, especially in low- and middle-income countries (LMICs), where surveillance infrastructure is underdeveloped. Bihar, India’s third most populous state and one of its least-resourced states, has remained largely absent from national AMR monitoring [...] Read more.
Background: Antimicrobial resistance (AMR) poses a significant threat to public health, especially in low- and middle-income countries (LMICs), where surveillance infrastructure is underdeveloped. Bihar, India’s third most populous state and one of its least-resourced states, has remained largely absent from national AMR monitoring initiatives. Methods: This study aimed to characterize the AMR infection landscape across five public tertiary care hospitals in Bihar over three years (2022–2024) and to assess the feasibility of integrating digital workflows for real-time microbiological reporting. Standardized antimicrobial susceptibility testing (AST) was performed on >48,000 urine, pus, and blood samples using CLSI guidelines. Facility-level data were digitized into an open-source AMR reporting system, enabling automated antibiogram generation. Results: The findings revealed substantial resistance: high resistance to beta-lactams, carbapenems, and fluoroquinolones across pathogens. For instance, E. coli sensitivity to nitrofurantoin varied from 86.5% at NMCH (Patna) to 44.7% at JLNMCH (Bhagalpur), while cephalosporin sensitivity in Klebsiella spp. dropped below 2% in several hospitals. MRSA prevalence exceeded 65% in two facilities, far above the national average of 47.8%. Digital integration led to a four-fold increase in culture testing in all facilities and improved data completeness and turnaround times. Spatial analysis and microbiology laboratory assessment revealed significant geographic disparities in diagnostic access, with facilities in remote districts facing delays of over four hours for basic testing. Conclusions: Our study is the first study from India to create such a broad, facility-associated AMR picture over time at a state level. Policy implications include the need for a state-level AMR surveillance dashboard, alignment of procurement with facility-specific resistance patterns, and routine stewardship audits. Clinically, this study demonstrates the utility of localized antibiograms for guiding empirical therapy in resource-limited settings. This study provides a scalable framework for embedding AMR surveillance into routine health system workflows in LMICs. Full article
(This article belongs to the Special Issue Antibiotic Stewardship Implementation Strategies)
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14 pages, 1012 KiB  
Article
Outcomes of Implementing a Multidimensional Antimicrobial Stewardship Program in a Medical Ward in a Third-Level University Hospital in Northern Italy
by Maria Mazzitelli, Daniele Mengato, Gianmaria Barbato, Sara Lo Menzo, Fabio Dalla Valle, Margherita Boschetto, Paola Stano, Cristina Contessa, Daniele Donà, Vincenzo Scaglione, Giacomo Berti, Elisabetta Mariavittoria Giunco, Tiziano Martello, Francesca Venturini, Ignazio Castagliuolo, Michele Tessarin, Paolo Simioni and Annamaria Cattelan
Antibiotics 2025, 14(7), 683; https://doi.org/10.3390/antibiotics14070683 - 5 Jul 2025
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Abstract
Background/Objectives: Antimicrobial stewardship programs (ASPs) optimize antimicrobial use, improving outcomes and reducing resistance. This study assessed the impact of a ward-specific ASP. Methods: A pre/post quasi-experimental study was conducted in an internal medicine ward at a tertiary hospital in Padua, Italy. [...] Read more.
Background/Objectives: Antimicrobial stewardship programs (ASPs) optimize antimicrobial use, improving outcomes and reducing resistance. This study assessed the impact of a ward-specific ASP. Methods: A pre/post quasi-experimental study was conducted in an internal medicine ward at a tertiary hospital in Padua, Italy. During the intervention year (September 2023–August 2024), a multidisciplinary team (infectious disease consultants, pharmacists, microbiologists, nurses, and hygienists) held bi-weekly ward-based audits, reviewing antimicrobial prescriptions and performing bedside assessments. Therapy adjustments followed guidelines and local epidemiology. Educational sessions and infection prevention and control (IPC) protocols were also reinforced. Outcomes were compared to the previous year, considering patient characteristics. The primary outcome was antimicrobial consumption (DDD/100 patient days, DDD/100PD); secondary outcomes included cost savings, length of stay (LOS), and mortality. Results: Fifty audits assessed 1074 patients and 1401 antimicrobial treatments. Patient characteristics were similar. Antibiotic suspension or de-escalation occurred in 37.9% and 22% of patients, respectively. AWARE ACCESS class use increased (+17.5%), while carbapenem (−54.4%) and fluoroquinolone (−42.0%) use significantly declined (p < 0.05). IPC and microbiological culture guidance were provided in 12.1% of cases. Antimicrobial consumption dropped from 107.7 to 84.4 DDD/100PD (p < 0.05). No significant changes in LOS or mortality were observed. Antimicrobial costs fell by 48.8% (with EUR 57,100 saved). Conclusions: ASP reduced antimicrobial consumption, improved prescription quality, and cut costs without compromising patient outcomes. Multidisciplinary collaboration, audits, and education proved essential. Future studies should assess long-term resistance trends and integrate rapid diagnostics for enhanced stewardship. Full article
(This article belongs to the Special Issue Antibiotic Stewardship Implementation Strategies)
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8 pages, 206 KiB  
Article
The Cost-Effectiveness of Beta-Lactam Desensitization in the Management of Penicillin-Allergic Patients
by Alicia Rodríguez-Alarcón, Santiago Grau, Silvia Gómez-Zorrilla and Carlos Rubio-Terrés
Antibiotics 2025, 14(7), 646; https://doi.org/10.3390/antibiotics14070646 - 25 Jun 2025
Viewed by 237
Abstract
Background/Objectives: Antibiotic management of hospitalized penicillin-allergic patients (PAPs) is associated with prolonged hospital stays, adverse reactions and treatment failure, resulting in increased healthcare costs. This study aimed to estimate the cost-effectiveness of beta-lactam desensitization (DES) in the management of PAPs. Methods: A [...] Read more.
Background/Objectives: Antibiotic management of hospitalized penicillin-allergic patients (PAPs) is associated with prolonged hospital stays, adverse reactions and treatment failure, resulting in increased healthcare costs. This study aimed to estimate the cost-effectiveness of beta-lactam desensitization (DES) in the management of PAPs. Methods: A cost-effectiveness analysis was performed using a probabilistic model with 1000 s-order Monte Carlo simulations. Hospital costs (in 2025 Euros) and effectiveness outcomes (cure and survival rates) were derived from a Spanish retrospective case–control study conducted between 2015 and 2022, which included 56 PAPs (14 in the desensitization group [DES] and 42 in the control group without DES [NDES]; ratio 1:3), and collected healthcare costs per patient. Results: The incremental cost of the DES group was EUR 37,805 (95% CI: EUR 2023–EUR 126,785), with a 100% probability of incurring additional costs compared to the NDES group. The cure rate was 16.5% higher in the DES group (95% CI: 13.3–20.0%), and the estimated gain in life-years per patient (LYG) was 1.42 (95% CI: 1.15–1.73) versus NDES. The cost per life-year gained (LYG) with DES versus NDES was EUR 24,618 ± EUR 19,535 (95% CI: EUR 1755–EUR 73,488). The probability that DES would be cost-effective (cost per LYG < EUR 25,000 and <EUR 30,000) was 61.1% and 100%, respectively. Conclusions: According to this analysis, DES appears to be a cost-effective option for managing PAPs. These findings should be confirmed in clinical studies with larger sample sizes. Full article
(This article belongs to the Special Issue Antibiotic Stewardship Implementation Strategies)
12 pages, 243 KiB  
Article
Adherence to Staphylococcus aureus Bacteremia Management Recommendations Before, During, and After the COVID-19 Pandemic: Prognostic Implications
by Elizabeth Lorenzo-Hernández, Francisco Rivas-Ruiz, Jorge Fernández-Casañas, Vanesa Puerto-Romero, Maria Dolores Martín-Escalante and Alfonso Del Arco-Jiménez
Antibiotics 2025, 14(6), 615; https://doi.org/10.3390/antibiotics14060615 - 18 Jun 2025
Viewed by 284
Abstract
Background/Objectives: This work aims to assess the evolution in the management of Staphylococcus aureus bacteremia (SAB) and the impact of the COVID-19 pandemic on it. SAB is associated with high morbidity and mortality, requiring structured management strategies. The COVID-19 pandemic led to major [...] Read more.
Background/Objectives: This work aims to assess the evolution in the management of Staphylococcus aureus bacteremia (SAB) and the impact of the COVID-19 pandemic on it. SAB is associated with high morbidity and mortality, requiring structured management strategies. The COVID-19 pandemic led to major changes in hospital workflows, potentially affecting the quality of SAB care. Methods: We conducted a retrospective per-protocol analysis of SAB episodes at Costa del Sol University Hospital (Marbella, Spain) across three periods: pre-pandemic, pandemic, and post-pandemic. Patients with early mortality or early transfer were excluded. Clinical variables, adherence to recommended management bundles, and outcomes were compared. Demographic characteristics were similar across the analyzed periods. Results: The incidence of SAB increased over time, with a notable rise post-pandemic. Key management indicators such as the identification of infection source and appropriate antibiotic therapy showed adherence rates of above 90%, while echocardiography exhibited an adherence rate of above 75% throughout the study. Adherence to the full management bundle was suboptimal, with no significant differences between periods. However, an appropriate treatment duration significantly improved in the post-pandemic group (p = 0.038). Mortality at 14 and 30 days was highest during the pandemic period (10.3% and 17.6%, respectively), although differences were not statistically significant. Complications and mortality were more frequent in patients with complete adherence to the bundle (p = 0.031). Conclusions: Despite stable or improved adherence to certain SAB management measures during the pandemic, mortality and complication rates did not significantly decrease, likely reflecting increased patient severity or healthcare system overload. These findings highlight the need for sustained, multidisciplinary, bedside-based approaches to SAB care, even during public health emergencies. Further research is needed to explore modifiable factors and enhance adherence to evidence-based recommendations. Full article
(This article belongs to the Special Issue Antibiotic Stewardship Implementation Strategies)
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