ESAC-Net indicators for antibiotic use in Piedmont, Italy: comparison with European standards

Background

The European Surveillance of Antimicrobial Consumption Network (ESAC-Net) offers standardised indicators to benchmark antibiotic prescribing across EU/EEA countries.Applying these metrics at sub-national level highlights geographic variability, particularly in high-use settings like Italy.This study assesses antimicrobial prescribing quality in Piedmont using ESAC-Net indicators benchmarked against national and European standards.

Methods

Antibiotic consumption data (2023-2024) were extracted from regional pharmaceutical databases, across hospital and community settings.ESAC-Net indicators included the community broad-to-narrow spectrum ratio (BtN) and the proportion of broad-spectrum and/or last-resort antibiotics over total hospital consumption. Access, Watch, Reserve (AWaRe) classification was applied to both settings. Analyses were stratified for geriatric (>65 years) and paediatric (0-13 years) populations.

Results

Community BtN improved from 12.66 (2023) to 10.79 (2024), surpassing the Italian average (13.6) but still more than twice the EU average (4.6, in 2024).The hospital proportion of broad-spectrum and/or last-resort antibiotic use decreased from 54% (2023) to 48% (2024), similar to Italy (52% in 2023), both still exceeding the ESAC-Net benchmark (40.1% in 2023).These trends reflect low Access antibiotics proportions in community (54.6%) and hospital (39.9%) settings, compared to ESAC-Net target (65%) and EU averages. Geriatric patients showed disproportionately high Watch antibiotics use in 2024 (49.5%), with a BtN of 15.92, versus 4.57 in paediatric patients.

Conclusions

Despite improvement, Piedmont’s prescribing indicators show persistent gaps versus EU standards, mirroring the Italian average. Stewardship interventions targeting geriatric populations are urgently needed. Sub-national ESAC-Net indicator monitoring is a feasible stewardship tool for countries with high intra-national heterogeneity, offering a model for comparable EU regions.

Key messages

• Piedmont’s antibiotic prescribing improved but remains far from EU standards. Geriatric patients are the priority target for stewardship interventions.

• Sub-national ESAC-Net monitoring reveals persistent prescribing gaps in Piedmont, offering a replicable stewardship model for high-consumption EU regions.