How a laboratory-based antimicrobial resistance (AMR) regional surveillance system can address large-scale and local AMR epidemiology: the MICRO-BIO experience.

Antimicrobial resistance is a significant threat to public health, with Italy experiencing substantial challenges in terms of AMR rate, surveillance system and activities to combat AMR. In response, the MICRO-BIO project was initiated as part of the National Plan to Combat Antibiotic Resistance by Region Lombardy health department. It was launched in 2018 with the aim of creating a surveillance tool by integrating data on bacterial isolates from microbiology laboratories. The participating laboratories were directly involved in reviewing and addressing discrepancies in the transmission data quality assessment. Despite the disruptions caused by COVID-19, 30 out of 33 laboratories in the Lombardy Region were successfully integrated by October 2023, with 1,201,000 microbiological data collected in the first nine months of 2023. In 2022 the analysis yielded 15,037 blood culture results from 20 labs passing validation. Data regarding the antimicrobial resistance profile of high-priority pathogens was analyzed at regional and single-hospital levels. The MICRO-BIO project represents a significant step toward strengthening AMR surveillance in a highly populated region. As a multi-disciplinary tool encompassing the fields of public health and IT (information technology), this tool has the potential to inform regional and local AMR epidemiology.

[Heart failure epidemiology in Apulia, Italy, from 2001-2006]. / Epidemiologia dello scompenso cardiaco nella regione Puglia tra il 2001 e il 2006.

BACKGROUND: Heart failure is one of the main causes of morbidity and mortality in western countries, engaging from 1% to 2% of the healthcare budget in Italy. The aim of this study was to evaluate the course of heart failure over time in the Apulia region on the basis of the hospitalization analysis. METHODS: Analyses of the directional informative system data of the Apulia region, Italy, coming from hospital discharge records, allowed the estimation of the overall admission rate in Apulia from 2001 to 2006, of admissions for cardiovascular disease and heart failure as the main diagnosis, classified according to age, average hospitalization rates and of discharge units. RESULTS: In Apulia, overall admissions decreased by 8.6% from 2001 to 2006, whereas the costs related to hospital admissions increased by 2.41%. Admissions for cardiovascular diseases decreased by 0.73% when shock and cardiac failure were excluded, whereas they increased by 1.3% when shock and cardiac failure were included. Admissions with DRG 127 stepped up by 15.26%; this increase was mainly related to a higher number of hospitalizations of patients > 75 years old. From 2001 to 2006, admissions for heart failure increased in Cardiology wards, whereas they decreased in coronary care units and Medicine wards. CONCLUSIONS: The data related to the increase in hospital admissions for heart failure are relevant for their economic and organizational impact, landing support to the need for effective patient management in order to reduce high early rehospitalization rates.