Digitalized Diagnostic-Therapeutic-Assistance Pathway for Multidrug-Resistant Organism Surveillance: Implementation Protocol and Preliminary Results

Abstract

Background: Healthcare-associated infections (HAIs) and multidrug-resistant organisms (MDROs) represent a major threat to patient safety and healthcare system sustainability. Prevention requires integrated, real-time, multidisciplinary approaches.

Objective: To describe the design, implementation, and preliminary evaluation of a digitalized Diagnostic-Therapeutic-Assistance Pathway (PDTA) for direct surveillance of MDROs/alert organisms, integrating artificial intelligence, electronic health records, and mobile audit tools within a provincial hospital network.

Methods: The pathway was developed by the Hospital Infection Control Committee (CC-ICA) of ASP Ragusa (Italy), involving all clinical units, the microbiology laboratory, territorial services, and general practitioners. The PDTA includes: (1) admission risk stratification; (2) electronic prescription with clinical decision support; (3) automated laboratory alerts (MALDI-TOF, PCR); (4) real-time notification and isolation activation; (5) AI-assisted case analysis and contact tracing; (6) on-site verification with digital checklists; (7) post-discharge follow-up; and (8) monthly clinical audit. The system is supported by an integrated IT architecture (Modulab 2.0, ICA-Tracker Platform, Mobile Audit App, multichannel alert system) with full GDPR compliance. Indicators were monitored from March 2025 to March 2026 across all 8 hospital units.

Results: During the 12-month observation period: mean laboratory-to-unit notification time decreased from 6.2 to 2.8 hours (p<0.001); isolation compliance improved from 78% to 96%; the electronic alert registry reached 100% completeness; on-site verification was performed within 24 hours in 98% of cases; MDRO transmission rate decreased by 28% (from 3.2 to 2.3 episodes/1,000 patient-days; p=0.018); broad-spectrum antibiotic consumption decreased by 22% (p<0.001); and user satisfaction scored 4.3/5. The system adoption rate was 92%.

Conclusions: A digitalized, multidisciplinary PDTA significantly improves HAI surveillance, reduces MDRO transmission, enhances antimicrobial stewardship, and increases process compliance. This model is replicable and scalable in other regional and national healthcare settings.