Assessing a regional antimicrobial stewardship intervention: Ivano-Frankivsk, Ukraine (2024-2025)

Background

Rising antimicrobial resistance (AMR) demands public health interventions to preserve antibiotic effectiveness. To shift clinical practice from mass empirical therapy to evidence-based, protocol-oriented prescribing, we implemented a systematic antimicrobial stewardship (AMS) intervention and monitored antibiotic consumption in the Ivano-Frankivsk region.

Methods

A systematic AMS intervention initiated in 2023 utilized the WHO AWaRe (Access, Watch, Reserve) system and implemented strict prescription audits, automated defined daily dose (DDD) monitoring, and mandatory infection control department approval of Reserve group (last-resort) antibiotics. To measure effectiveness over time, a retrospective comparative analysis compared antibiotic consumption in 2024 vs 2025 across regional healthcare facilities (hospitals, primary care), excluding social (behavioral, palliative) and military institutions.

Results

Compared with 2024, total antibiotic use in 2025 decreased by 37% (15,184 to 9,514 DDDs) and average hospital use fell by 35% (0.345 to 0.223 DDDs/100 bed days). In primary care, Access group prescriptions rose from 61% to 78% (goal 95%); Reserve group prescriptions dropped notably from 23% to 1%. Hospital prescriptions guided by bacterial cultures increased from 22% to 41% (goal ∼100%). We reduced use of Reserve antibiotics (linezolid −50%; colistin −50%) and Watch antibiotics (meropenem −53%; ceftriaxone −50% [although +85% increased cefuroxime use requires local protocol review]).

Conclusions

Systematic implementation of an AMS intervention, with strict auditing and strong institutional controls, effectively reduced inappropriate use and overuse of antibiotics, demonstrating a systematic transition to evidence-based therapy. Despite these improvements, current usage patterns still warrant and are informing policy efforts to enhance AMS protocols and implementation to further improve appropriate antibiotic use, and to monitor and combat local AMR.

Key messages

• Systemic control and strict auditing significantly reduced the use of “Reserve” antibiotics and overall consumption.

• A successful regional transition from empirical to evidence-based antibiotic therapy.