Hospital Antibiotic Pressure and Veterinary Antimicrobial Use: A One Health Analysis in Italy, 2022

Background

Antimicrobial resistance (AMR) requires integrated One Health surveillance. In 2022, we coordinated the latest national hospital point prevalence survey (PPS3) in Italy. This study provides a national-level One Health overview of critically important antibiotic (CIA) classes for stewardship, in comparison to veterinary antimicrobial consumption data (ESVAC).

Methods

A descriptive ecological analysis was conducted using 2022 national aggregate data. We analyzed healthcare-associated infection (HAI) prevalence, antibiotic use, and resistance markers in acute care hospitals, alongside veterinary consumption (mg/PCU) of 3rd-4th generation cephalosporins, fluoroquinolones, and polymyxins.

Results

Among 60,404 patients included in PPS3, 41.7% received antibiotics. Ceftriaxone (16.1%) and penicillins with enzyme inhibitors were the most common agents. Enterobacterales resistance in HAIs reached 31.4% for 3rd-generation cephalosporins and 13.3% for carbapenems. In the veterinary sector, total sales in 2022 fell to 157.5 mg/PCU, a 46.6% reduction since 2016. CIA consumption remained low: 3rd-4th generation cephalosporins (0.08), fluoroquinolones (0.90), and polymyxins (0.58). The three most sold veterinary classes remain penicillins, tetracyclines, and sulfonamides.

Conclusions

Italy’s surveillance reveals an operational misalignment between sectors. Human data, supported by the national carbapenem-resistant Enterobacterals surveillance report for 2022 (showing 4.3 cases/100,000 inhabitants; 96.6% K. pneumoniae), emphasize high resistance burden in hospitals. While the veterinary sector successfully reduced CIA use, and EU zoonoses reports indicate stable trends, high resistance to common antimicrobials and increasing ciprofloxacin resistance in both human and animal isolates persist. These findings reinforce the necessity of a One Health approach to harmonize stewardship priorities across all sectors.

Key messages

• Italy shows a high burden of carbapenem-resistant infections in hospitals while veterinary efforts have reduced CIA use. Resistance to commonly used antibiotics remains a shared concern.

• The misalignment between human and veterinary sectors highlights the urgency of antimicrobial stewardship and an integrated One Health approach.