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. 2025 Jul 9;14(1):86.
doi: 10.1186/s13756-025-01604-8.

Assessment of the implementation of the Italian National action plan to combact antimicrobial resistance (PNCAR) 2017-2021 through SPiNCAR-1: results for the Piedmont Region, 2022

Stefania Di Giacomo  1 , Luca Bresciano  2 , Lorenza Ferrara  3   4 , Sabina Pederiva  3 , Carla Maria Zotti  1 , Fortunato Paolo D'Ancona  5 , Costanza Vicentini  1 ; Collaborating Group
Collaborators, Affiliations

Assessment of the implementation of the Italian National action plan to combact antimicrobial resistance (PNCAR) 2017-2021 through SPiNCAR-1: results for the Piedmont Region, 2022

Stefania Di Giacomo et al. Antimicrob Resist Infect Control. .

Abstract

Background: The Italian National action plan to contrast antimicrobial resistance (PNCAR) was adopted in Italy with the aim of reducing antimicrobial resistance (AMR) rates through a "One Health" approach. The project "Support for the National Plan to Combat Antimicrobial Resistance (SPiNCAR)" was developed to evaluate the level of implementation of actions outlined by the PNCAR, through a self-assessment tool, addressed to regional and local health authorities. This study presents the findings of the first use of the SPiNCAR tool in the Region of Piedmont, detailing the level of implementation as of 31 December 2022.

Methods: The self-assessment questionnaire is divided into 7 central "areas" representing the main actions against AMR: governance, surveillance and monitoring, appropriate use of antimicrobials, healthcare-associated infection (HAI) control and prevention, education and training, alliance among stakeholders, evaluation of the impact and implementation of the program. Areas are structured into two or more items called "standards", subdivided into "criteria". Different questionnaires were developed for Regional and Local Authorities. Scores were calculated as the percentage of criteria met within each area, aggregated at both regional and local levels.

Results: By analysing results at the regional level, it was possible to identify domains of strength in the areas of Governance (79%), Appropriate use of antimicrobials (70%), HAI Control and Prevention (68%) and areas for improvement in Alliance among Stakeholders (18%), Training (33%) and Surveillance (41%). Local authorities showed encouraging median results in Surveillance (37%), Appropriate Use of Antimicrobials (22,5%), and HAI Control and Prevention (21,5%), whereas Implementation (10,5%), Education and Training (8%) and Alliance among Stakeholders (2,5%) need to be improved.

Conclusions: The first SPiNCAR assessment offered valuable insights to enhance healthcare quality; the evaluation identified stakeholder engagement and training as priority areas for improvement and targeted interventions for AMR containment.

Keywords: Antimicrobial resistance; Implementation; Italy; National plan to combat antimicrobial resistance; One health; Self-assessment.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This was a quality improvement project coordinated by public entities, for which no Institutional Review Board approval was required. As no patient level data were collected, obtaining informed consent was not necessary. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Graphical representation of regional level SPiNCAR scores achieved by the Region of Piedmont, Italy, 2022The radar charts represent the percentage score obtained considering the sum of standards for each area (in blue) compared to the minimum criteria that should be met for each area (in orange), expressed as a percentage
Fig. 2
Fig. 2
Graphical representation of local level SPiNCAR scores achieved in the Region of Piedmont, Italy, 2022. Median score of the Local health authorities (in red) and of Hospital trusts (in green) of the Piedmont Region obtained considering the sum of all standards for each area
See this image and copyright information in PMC

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