Antimicrobial resistance (AMR) remains a major public health concern in the European Union/European Economic Area (EU/EEA), with estimates showing that each year more than 670 000 infections are due to bacterial resistance to antibiotics and approximately 33 000 people die as a direct consequence. If no action is taken, it is estimated that AMR will result in a loss of US$100 trillion in economic output each year by 2050 and most importantly in the loss of 10 million lives worldwide. Antibiotics are used too much and often inappropriately, although there are signs of improvement. Italy is a country with a high rate of resistance, and the regional situation is patchy. Approximately one-third of deaths caused by AMR in Europe occur in Italy (c. 11 000).
On the verge of being finally approved is the new National Action Plan on Antimicrobial Resistance 2022–2025 (Piano Nazionale di Contrasto all’Antibiotico-Resistenza 2022–2025 – PNCAR) drafted by the Ministry of Health to outline the strategic guidelines and operational directions required to address the emergence of AMR over the following years, at the national, regional and local levels through a multidisciplinary vision and a multi-sector “One Health” approach.
Replacing the previous plan (PNCAR 2017–2020), the new Plan provides a strategy to combat antibiotic resistance based on inclusive governance. It is organized into four cross-cutting areas:
- Training;
- Information, communication and transparency;
- Research, information and bioethics;
- National and international cooperation
and three vertical pillars dedicated to key preventative interventions and controls:
- the integrated surveillance and monitoring of antibiotic resistance, antibiotic use, care-related infections and environmental monitoring;
- the prevention of care-related infections in hospital and community settings and infectious diseases and zoonoses (diseases that can be transmitted between animals and humans via direct or indirect contacts);
- the appropriateness of antibiotic use in both human and veterinary settings and proper drug management and disposal.
In addition, the Plan has six main objectives:
- reinforcing the One Health approach through the development of coordinated national surveillance of AMR and antibiotic use, preventing the spread of AMR in the environment;
- strengthening Healthcare Associated Infections (HCAI) prevention and surveillance in hospitals and community settings;
- promoting the appropriate use of antibiotics and to reduce the frequency of infections caused by resistant microorganisms among humans and animals;
- fostering innovation and research on the prevention, diagnosis and treatment of antibiotic-resistant infections;
- strengthening national cooperation and Italy's participation in international initiatives in combating AMR;
- improving public awareness and promoting training of health and environmental professionals on countering AMR.
The Plan also includes several practical recommendations aimed at various stakeholders (manufacturers, pharmacists, health professionals and patients). For example, it recommends that general practitioners and paediatricians prescribe antibiotics following guidelines based on the latest scientific evidence; it also recommends that schools implement programs and actions to promote awareness and to help counteract AMR.