{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T04:38:19Z","timestamp":1780375099296,"version":"3.54.1"},"reference-count":33,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T00:00:00Z","timestamp":1658966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"MSD, ALIFAXe Thermo Fisher Scientific"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Multidrug resistance has become a serious threat for health, particularly in hospital-acquired infections. To improve patients\u2019 safety and outcomes while maintaining the efficacy of antimicrobials, complex interventions are needed involving infection control and appropriate pharmacological treatments in antibiotic stewardship programs. We conducted a multicenter pre-post study to assess the impact of a stewardship program in seven Italian intensive care units (ICUs). Each ICU was visited by a multidisciplinary team involving clinicians, microbiologists, pharmacologists, infectious disease specialists, and data scientists. Interventions were targeted according to the characteristics of each unit. The effect of the program was measured with a panel of indicators computed with data from the MargheritaTre electronic health record. The median duration of empirical therapy decreased from 5.6 to 4.6 days and the use of quinolones dropped from 15.3% to 6%, both p &lt; 0.001. The proportion of multi-drug-resistant bacteria (MDR) in ICU-acquired infections fell from 57.7% to 48.8%. ICU mortality and length of stay remained unchanged, indicating that reducing antibiotic administration did not harm patients\u2019 safety. This study shows that our stewardship program successfully improved the management of infections. This suggests that policy makers should tackle multidrug resistance with a multidisciplinary approach based on continuous monitoring and personalised interventions.<\/jats:p>","DOI":"10.3390\/jcm11154409","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T22:43:26Z","timestamp":1659048206000},"page":"4409","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8506-1018","authenticated-orcid":false,"given":"Giulia","family":"Mandelli","sequence":"first","affiliation":[{"name":"Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6997-3893","authenticated-orcid":false,"given":"Francesca","family":"Dore","sequence":"additional","affiliation":[{"name":"Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy"},{"name":"Associazione GiViTI\u2014Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8496-1620","authenticated-orcid":false,"given":"Martin","family":"Langer","sequence":"additional","affiliation":[{"name":"Associazione GiViTI\u2014Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy"},{"name":"Emergency-Ong, 20128 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4902-0144","authenticated-orcid":false,"given":"Elena","family":"Garbero","sequence":"additional","affiliation":[{"name":"Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy"},{"name":"Associazione GiViTI\u2014Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Alagna","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6108-8286","authenticated-orcid":false,"given":"Andrea","family":"Bianchin","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care, Ospedale Civile San Valentino di Montebelluna, 31044 Montebelluna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Ciceri","sequence":"additional","affiliation":[{"name":"Associazione GiViTI\u2014Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy"},{"name":"Anesthesia and Intensive Care, Ospedale Alessandro Manzoni di Lecco, 23900 Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2661-6183","authenticated-orcid":false,"given":"Antonello","family":"Di Paolo","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Universit\u00e0 di Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Giani","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, Universit\u00e0 di Firenze, 50134 Firenze, Italy"},{"name":"Clinical Microbiology and 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Ranica, Italy"},{"name":"Anesthesia and Intensive Care, Ospedale San Giovanni Bosco, 10154 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Viaggi","sequence":"additional","affiliation":[{"name":"Associazione GiViTI\u2014Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy"},{"name":"Neuro Intensive Care Unit, Department of Anesthesiology, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3101-4259","authenticated-orcid":false,"given":"Guido","family":"Bertolini","sequence":"additional","affiliation":[{"name":"Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3525-3249","authenticated-orcid":false,"given":"Stefano","family":"Finazzi","sequence":"additional","affiliation":[{"name":"Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy"},{"name":"Associazione GiViTI\u2014Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1016\/j.addr.2005.04.005","article-title":"Clinical Impact and Relevance of Antibiotic Resistance","volume":"57","author":"French","year":"2005","journal-title":"Adv. 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