ESAC-Net indicators for antibiotic use in Piedmont, Italy: comparison with European standards
Abstract
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.
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BibTeX
@article{imbriano2026esacnet,
title = {{ESAC-Net indicators for antibiotic use in Piedmont, Italy: comparison with European standards}},
author = {V Imbriano and V Picottino and L Bresciano and L Ferrara and CM Zotti and C Vicentini},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1872},
url = {https://doi.org/10.1093/eurpub/ckag169.1872},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - ESAC-Net indicators for antibiotic use in Piedmont, Italy: comparison with European standards
AU - V Imbriano
AU - V Picottino
AU - L Bresciano
AU - L Ferrara
AU - CM Zotti
AU - C Vicentini
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1872
UR - https://doi.org/10.1093/eurpub/ckag169.1872
AB - 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.
SN - 1101-1262
SN - 1464-360X
ER -