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. 2025 Sep 1;18(11):102943.
doi: 10.1016/j.jiph.2025.102943. Online ahead of print.

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

Jaslyn Doshi  1 , Yen Ngoc Pham  2 , Thuy Thu Ma  2 , Linh Thuy Duong  2 , Van Thi Thuy Pham  3 , Rodney James  4 , Qingbin Li  5 , Thuy Thi Thu Nguyen  3 , Tuan Anh Huynh  6 , Thu Minh Pham Vo  7 , Anh Duc Hoang  8 , Matthew Watts  9 , Justin Beardsley  10 , Thu Anh Nguyen  11 , Greg J Fox  12
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Free article

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

Jaslyn Doshi et al. J Infect Public Health. .
Free article

Abstract

Background: 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.

Methods: 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.

Results: 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)].

Conclusion: 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.

Keywords: Antimicrobial consumption; Antimicrobial resistance; Antimicrobial stewardship; Appropriateness; District hospitals; Vietnam.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declare that the Australian Department of Foreign Affairs and Trade (DFAT) provided funding for this study. The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

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