National surveillance of data on antibiotic use and bacterial resistance in healthcare facilities (HCFs), conducted in accordance with the methodology of the National Mission for the Surveillance and Prevention of Antibiotic Resistance in Healthcare Facilities (Spares) collected data from 1,752 facilities for the "antibiotic consumption" component and 1,066 for the "bacterial resistance" component in 2020. Overall antibiotic consumption was 286 defined daily doses (DDD) per 1,000 hospital days, with variations across HCFs and clinical sectors ranging from 38 in psychiatry to 1,145 in intensive care. The proportion of broad-spectrum antibiotics (according to the indicator defined by the ECDC) was 35%. In a cohort of healthcare facilities, overall antibiotic consumption was higher in 2020 than in 2019, with a higher proportion of broad-spectrum antibiotics. Regarding bacterial resistance, 8.3% of Enterobacteriaceae strains produced extended-spectrum beta-lactamases (ESBLs) and 0.2% produced carbapenemases. Among Staphylococcus aureus strains, 14% were methicillin-resistant (MRSA). The proportions of MRSA and ESBL-producing strains were lower than in 2019, continuing the trends observed since 2016; the higher incidence of ESBL-producing strains, against the backdrop of altered hospital activity in 2020, remains to be explored. Despite the ongoing health crisis in 2021, healthcare facilities mobilized to participate in national surveillance, enabling the identification of avenues for further work to continue the fight against antibiotic resistance.