Antimicrobial use in referral hospitals in Viet Nam: A multi-center point prevalence survey

BACKGROUND AND OBJECTIVES: Despite existing regulations promoting prudent antibiotic use, antimicrobial stewardship (AMS) remains suboptimally implemented in referral hospitals in Viet Nam, partly due to limited availability of real-time antimicrobial use data. This study aimed to describe patterns of antimicrobial use and identify potential targets for AMS improvement in these settings. METHODS: A point-prevalence survey was conducted across five referral hospitals in Viet Nam between November 2022 and March 2023. RESULTS: Out of 2170 patients admitted to participating hospitals, 1244 (57.3%) received antimicrobial treatment on the day of point prevalence survey. Of these, 199 (16.0%) were admitted to ICUs, 682 (54.8%) had at least one comorbidity, and 169 (13.6%) had hospital-acquired infections (HAIs). Pathogen-targeted therapy accounted for 9.6% of therapeutic prescriptions. Among surgical prophylactic prescriptions, 98.1% were continued for more than 24 hours. Out of 1773 antibiotic prescriptions, 1235 (69.7%) were classified as Watch antibiotics according to the WHO AWaRe classification. Pneumonia and lower respiratory tract infections were the most common indications (520 prescriptions, 29.3%) and were associated with higher use of Watch antibiotics (OR 2.26, 95% CI 1.70-3.04; P < 0.001). HAIs were associated with increased use of Reserve antibiotics (OR 7.51, 95% CI 4.10-14.17; P < 0.001). Compliance with local prescribing guidelines was high (98.2%), as was documentation of indication (90.1%), whereas documentation of stop or review dates was low (5.3%). CONCLUSION: Antimicrobial use in referral hospitals in Viet Nam was characterized by limited targeted treatment, prolonged surgical prophylaxis, high reliance on Watch antibiotics, and suboptimal documentation. Strengthening microbiology capacity, integrating AMS with infection prevention and control, and prioritizing targeted stewardship interventions are needed to address these gaps.