Antimicrobial stewardship in Vietnamese hospitals

Abstract

Antimicrobial resistance (AMR) remains a critical global health challenge, particularly in low- and middle-income countries (LMICs). Antimicrobial stewardship (AMS) programs comprise a pivotal solution to the problem of excessive and inappropriate antimicrobial use. Vietnam presents a particularly relevant context for evaluating AMS interventions due to its high burden of AMR, widespread antimicrobial overuse, and limited resources. This thesis evaluated antimicrobial consumption, prescribing appropriateness, and multidrug-resistant organism (MRO) carriage in Vietnamese district hospitals. It also assessed the feasibility and impact of implementing an AMS program in these settings. A systematic review and meta-analysis synthesised evidence on antimicrobial use and AMS interventions in Vietnam, revealing limited data from district hospitals. To address this gap, a pilot before-and-after study was conducted in four district hospitals, incorporating AMS committees, antimicrobial guidelines, healthcare worker training and education, and audit and feedback sessions. Antimicrobial consumption and prescribing appropriateness were measured pre- and post-intervention. MRO carriage was also assessed.

A cluster-randomised controlled trial was then conducted to evaluate the same AMS intervention’s impact on prescribing practices, antimicrobial use, costs, and mortality.

Findings demonstrated the feasibility of AMS implementation in resource-limited settings. While inappropriate prescribing remained high, modest improvements were seen in prescribing appropriateness and MRSA carriage rates post-intervention. No significant reductions were observed in antimicrobial consumption or costs.

These findings underscore the need for a phased approach to AMS in district hospitals. Sustained, locally adapted efforts are essential to realise long-term stewardship gains and contribute to AMR containment nationally and globally.