{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T01:08:12Z","timestamp":1788743292831,"version":"build-2803163510"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002803","name":"Fondazione Cariplo","doi-asserted-by":"publisher","award":["2021-423"],"award-info":[{"award-number":["2021-423"]}],"id":[{"id":"10.13039\/501100002803","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009882","name":"Regione Lombardia","doi-asserted-by":"publisher","award":["DGR XII\/1730\u201315\/01\/2024"],"award-info":[{"award-number":["DGR XII\/1730\u201315\/01\/2024"]}],"id":[{"id":"10.13039\/501100009882","id-type":"DOI","asserted-by":"publisher"}]},{"name":"EPIFARM-Pharmaco-Epidemiology"},{"DOI":"10.13039\/501100007601","name":"European Union\u2018s Horizon 2020 Research and Innovation Program","doi-asserted-by":"publisher","award":["965265"],"award-info":[{"award-number":["965265"]}],"id":[{"id":"10.13039\/501100007601","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Antimicrobial stewardship (AMS) is essential to tackle antimicrobial resistance. Antibiotic consumption (AC) surveillance provides evidence to guide AMS interventions. This study investigated in-hospital AC trends in Lombardy, Italy (2017\u20132024), with particular focus on the impact of COVID-19.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>AC was expressed as DDDs per 100 bed days (absolute AC), relative proportions of Access\/Watch\/Reserve antibiotics (relative AC), Access-to-Watch index, and Access-to-(Watch\u200a+\u200aReserve) index. Analyses were stratified by ward type\u2014medical (MUs), surgical (SUs), and intensive care units (ICUs)\u2014and timeframes: pre\u2013COVID-19 (01\/2017\u201302\/2020), COVID-19 onset (02\u201303\/2020), COVID-19 (03\/2020\u201305\/2023), and post\u2013COVID-19 (05\/2023\u201312\/2024).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Despite a surge in total AC in 2017\u20132024, relative Access AC rose while relative Watch AC declined, resulting in an increase of the Access-to-Watch and Access-to-(Watch\u200a+\u200aReserve) indexes, except in ICUs. A transient reversal of such favourable trends was observed at COVID-19 onset. Nevertheless, the WHO 2023 target of \u226560% total AC being Access was not achieved; furthermore, Access-to-Watch and Access-to-(Watch\u200a+\u200aReserve) indexes constantly remained &amp;lt;1, except for SUs. A downward trend in Access-to-Watch and Access-to-(Watch\u200a+\u200aReserve) indexes was registered in the post-pandemic period. Reserve AC increased across time, periods and wards, exceeding the expected levels obtained using projections from pre\u2013COVID-19 data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings highlight substantial shifts in in-hospital AC in Lombardy during the period 2017\u20132024, with concerning increases in Reserve antibiotics and an enduring failure to meet the 2023 WHO target of \u226560% Access antibiotics especially in MUs and ICUs, underscoring the need for reinforced AMS policies in the post-pandemic era.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkag314","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:14:57Z","timestamp":1788520497000},"source":"Crossref","is-referenced-by-count":0,"title":["In-hospital antibiotic consumption in Lombardy, Italy (2017\u20132024): a retrospective analysis of 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