Feasibility of an antimicrobial stewardship program in four district hospitals in Vietnam

Excessive and improper use of antimicrobials is a major driver of antimicrobial resistance. Antimicrobial stewardship (AMS) addresses this by promoting judicious use of antimicrobials. This study evaluated the feasibility and effectiveness of an AMS program in district hospitals in Vietnam.

A before-and-after study was undertaken in four district hospitals in Vietnam over 6 months. Interventions included (i) establishing AMS committees and teams, (ii) distribution of antimicrobial guidelines, (iii) healthcare worker training, and (iv) conducting periodic standardised audits of appropriateness of antimicrobial prescriptions, followed by tailored feedback. The co-primary outcomes were (i) monthly antimicrobial consumption in the hospital and (ii) appropriateness of antimicrobial prescribing according to guidelines, before and after the AMS program. Secondary outcomes included changes in antimicrobial costs and all-cause mortality.

The AMS program was successfully implemented with strong stakeholder engagement and high staff participation across all four hospitals. At baseline, 79.0 % (95 % CI: 74.9 %, 83.7 %) of 454 antimicrobial prescriptions were inappropriate, primarily due to prolonged duration, overly broad-spectrum agents, or incorrect dosing. No improvement was observed post-intervention, with 80.3 % (95 % CI: 77.4 %, 83.1 %) of 992 prescriptions deemed inappropriate. A modest reduction in antimicrobial consumption was seen post-intervention, with a decrease of 4.2 DDD/100 bed-days per month (95 % CI: - 6.2, - 2.3). Antimicrobial costs were unchanged. All-cause mortality reduced post-intervention [RR = 0.32 (95 % CI: 0.09, 0.92)].

AMS interventions were feasible to implement in district hospitals in Vietnam and resulted in modest reductions in antimicrobial consumption and all-cause mortality. However, the persistently high rates of inappropriate prescribing highlight the need for broader implementation and strengthening of stewardship efforts to more effectively address key drivers of antimicrobial resistance at the district level.