SPiNCAR: A systematic model to evaluate and guide actions for tackling AMR

Area of Science:

• Public Health
• Infectious Disease Control
• Healthcare Management

Background:

• Italy exhibits critically high levels of antimicrobial resistance (AMR).
• A National Action Plan on Antimicrobial Resistance (PNCAR) was established, aligning with European Union recommendations and ECDC findings.
• The SPiNCAR project was initiated to support and standardize PNCAR implementation across regional and local healthcare authorities.

Purpose of the Study:

• To develop a harmonized framework for implementing the National Action Plan on Antimicrobial Resistance (PNCAR) in Italy.
• To create a tool that supports and standardizes AMR control strategies at regional and local healthcare levels.
• To facilitate the monitoring and planning of interventions to combat antimicrobial resistance.

Main Methods:

• A framework was constructed using scientific literature and national/international guidelines.
• Key intervention areas for AMR were identified, followed by the development of standards and criteria for regional authorities and local trusts.
• Methodology included team discussions, Delphi methodology for consensus, and validation via a pilot study.

Main Results:

• A framework encompassing seven areas aligned with the PNCAR structure was finalized: Governance, Surveillance and Monitoring, Appropriate Use of antimicrobials, Healthcare-associated Infections (HAIs) control and prevention, Education and Training, Alliance among Stakeholders, and Implementation.
• The regional framework includes 34 standards with 264 criteria, while the local version comprises 36 standards with 279 criteria.
• The developed tool provides a structured approach to assessing and improving AMR strategies.

Conclusions:

• The SPiNCAR framework, tailored to the Italian context using international evidence, enables continuous monitoring of progress in AMR control.
• It serves as a vital tool for planning future actions and ensuring consistent implementation of national AMR strategies.
• The tool supports evidence-based decision-making for enhancing antimicrobial stewardship and reducing AMR at all healthcare levels.