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Antibiotic use in Vietnamese hospitals: A multicenter point-prevalence study

https://doi.org/10.1016/j.ajic.2011.10.020Get rights and content

Background

Inappropriate antibiotic prescribing appears to be common worldwide and is contributing to the selection of resistant organisms. This study examined the prevalence of antibiotic prescription and the appropriateness of indications for these prescriptions in 36 representative general hospitals across Vietnam.

Methods

A point-prevalence study was performed between February and December 2008. All inpatients on the day of the survey were included in the analysis. Standard published guidelines were used to evaluate the appropriateness of indications for antibiotic prescription.

Results

On the day of the study, 5,104 of 7,571 patients (67.4%) were receiving antibiotic therapy. The antibiotic prescription rate was highest in surgery wards (93.2%) and lowest in medical wards (48.2%). Of the 5,104 patients receiving antibiotics, the most commonly prescribed agents were cephalosporins (70.2%), penicillins (21.6%), and aminoglycosides (18.9%). Approximately one-third of the patients (1,573 of 5,104) had an inappropriate indication for prescription. Risk factors independently associated with inappropriate indication for antibiotic prescription were seen in hospitals at the national level, obstetrics and gynecology departments, and surgical wards.

Conclusions

Our data indicate a high rate of antibiotic use in Vietnamese hospitals, and also a high prevalence of inappropriate indications for antibiotic prescriptions. These findings suggest important areas for intervention and implementation of antibiotic stewardship policies in Vietnamese hospitals.

Section snippets

Setting

Vietnam has 3 levels of hospitals: national (39 general and specialized hospitals), provincial (394 general and specialized hospitals), and district (640 general hospitals). To avoid intrinsic differences among participating hospitals, we included only general hospitals in this study. A list of general hospitals providing medical and surgical services and had an infection control team was obtained from the Vietnamese Ministry of Health and used as a sampling frame. The study protocol was then

Patient demographics

A total of 7,571 inpatients were surveyed in 36 hospitals (2 national level, 18 provincial level, and 16 district level), including 3,803 males (50.2%) and 3,768 females (49.8%), with a mean age of 42.3 ± 23.8 years (age range, 2-96 years). There were 4,105 (54.2%) patients on medical wards, 1,910 (25.2%) patients on surgical wards, 694 (9.2%) on pediatric wards, 508 (6.7%) on obstetrics and gynecology wards, and 354 (4.7%) in intensive care units. The majority of the patients surveyed were

Discussion

We found that a large number (67.4%) of hospitalized patients received antibiotics and that 30.8% of those antibiotics were considered inappropriately indicated. The prevalence of antibiotic prescription in this study is similar to that reported in previous studies in developing countries. Those studies focused mainly on the prevalence of antibiotic use, which ranged from 62.8% to 77.8%.8, 16 However, our rate is higher than the prevalence reported in previous studies conducted in European

Acknowledgment

We thank the infection control teams from the participating hospitals and the nonprofit Epidemiological and Clinical Research Information Network (ECRIN), which contributed to the data collection and management of this study.

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    Comparison with adherence to 2021-guidelines found an increase in guidelines adherence to 35% and the proportion of use which could not be assessed reduced from 25% to 14%. This is much lower than estimates of appropriate antimicrobial use from other Asian countries (Vietnam (69·2%) in 2008, Myanmar (31·9%) in 2019, Indonesia (52·2%) in 2019 and India (77·4%) in 2017).13,22,23,27 Globally, the appropriateness of antimicrobial prescriptions based on local guidelines has been shown to range from 64·1% (Latin America) to 85·8% (North America).8

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Supported by research funds from the Vietnamese Ministry of Health.

Conflict of interest: None to report.

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