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Mediterranean Journal of Pharmacy and Pharmaceutical Sciences
https://ppj.org.ly/article/doi/10.5281/zenodo.15870874

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Original article

Antibiotic stewardship in a Vietnamese public security hospital: Addressing antimicrobial resistance challenges through the AWaRe framework

Hoang-Phu Nguyen, Van-Thanh Ha, Thi-Van-Anh Tran, Hai-Anh Ha

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Abstract

Antimicrobial resistance poses a critical threat to global health, exacerbated by inappropriate antibiotic usage. This study evaluates antibiotic consumption at Hospital 199, a public security hospital in Vietnam, using the defined daily dose per 100 bed-days and the World Health Organization AWaRe classification framework. Data were collected retrospectively from inpatient departments over 2022, analyzing prescribing trends to assess stewardship effectiveness and identify areas for improvement. The findings reveal a total antibiotic usage rate of 60.8 defined daily dose per 100 bed-days, predominantly driven by watch antibiotics (63.8%), followed by access antibiotics (36.2%), and minimal use of reserve antibiotics (0.0003%). Critical care departments, such as anesthesiology and intensive care, reported the highest consumption (190.54 DDD/100 bed-days), which may reflect the complexity of care provided and potential empirical prescribing practices, or an elevated infectious burden. β-lactam antibiotics accounted for 59.4% of total use, with third-generation cephalosporins representing the largest subgroup at 40.2% of defined daily doses. While adherence to stewardship principles was evident in the limited use of reserve antibiotics, the reliance on broad-spectrum agents highlighted systemic challenges, including empirical prescribing practices and limited diagnostic capacity. This study highlights the need for targeted interventions to promote access to antibiotics, reduce over-reliance on watch agents, and enhance diagnostic support. By aligning local practices with World Health Organization guidelines, Hospital 199 demonstrates its potential to combat antimicrobial resistance effectively. These findings offer insights for similar low- and middle-income settings, contributing to global efforts to mitigate resistance and optimize antibiotic stewardship.

Keywords

Antibiotic consumption, antibiotic resistance, AwaRe, defined daily dose, Hospital

References

  1. Tamer AA. The global threat of multidrug-resistant pathogens: A call for action. EC Microbiology. 2024; 20: 01-09. doi: Nil.
  2. Ha H-A, Yang J-S, Tsai F-J, Li C-W, Cheng Y-D, Li J, et al. Establishment of a novel temozolomide resistant subline of glioblastoma multiforme cells and comparative transcriptome analysis with parental cells. Anticancer Research. 2021; 41(5): 2333-2347. doi: 10.21873/anticanres.15008
  3. Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. The Lancet. 2022; 399(10325): 629-655. doi: 10.1016/ S0140-6736(21)02724-0
  4. Mittal N, Tayal A, Kumar S, Dhawan R, Goel N, Mittal R. Longitudinal trends in in-patient antibiotic consumption according to the WHO access, watch, reserve (AWaRe) antibiotic groups and cost: An analysis of data at a national antimicrobial consumption network (NAC-NET) site in North India over 7 years (2017-2023). Antibiotics. 2024; 13(7): 673. doi: 10.3390/antibiotics13070673
  5. Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M, et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. The Lancet Global Health. 2018; 6(6): e619-e29. doi: 10.1016/s2214-109x(18)30186-4
  6. Vu TVD, Do TTN, Rydell U, Nilsson LE, Olson L, Larsson M, et al. Antimicrobial susceptibility testing and antibiotic consumption results from 16 hospitals in Vietnam: The VINARES project 2012-2013. Journal of Global Antimicrobial Resistance. 2019; 18: 269-278. doi: 10.1016/j.jgar.2019.06.002
  7. Thomas SA, Mathew P, Ranjalkar J, Nguyen TBV, Giao VTQ, Chandy SJ. Public perception and community-level impact of national action plans on antimicrobial resistance in Vietnam. JAC-Antimicrobial Resistance. 2023; 6(1): dlad146. doi: 10.1093/jacamr/dlad146
  8. Smeda H, Murghem A, Khapoli A, Gaunos S, Alahrish R, Sherif FM, Alsharif SM. Knowledge, attitude and pattern of antibiotic utilization among Libyan University students in Zawia. Iberoamerican Journal of Medicine. 2020; 2(3): 161-166. 10.5281/zenodo.3746060   
  9. Alhaddad FE, Abuleid KM, Aljleedi LA. Dispensing of antibiotics in community pharmacy: An analytical study. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2023, 3(4): 26-32. doi: 10.5281/zenodo.10144799
  10. Elfowiris AO, Majed NSS. Antibiotic prescribing in pediatric health care service. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2022; 2(3): 12-16. doi: 10.5281/zenodo.7115130
  11. Torumkuney D, Kundu S, Vu GV, Nguyen HA, Pham HV, Kamble P, et al. Country data on AMR in Vietnam in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicines and clinical outcome. Journal of Antimicrobial Chemotherapy. 2022; 77(Suppl 1): i26-i34. doi: 10.1093/jac/dkac214
  12. Meerah WAA Evaluation of self-medication with antibiotics in Libyan community. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2023; 3(1): 77-81. doi: 10.5281/zenodo.7771724
  13. Nguyen-Thi H-Y, Bui TV, Tran-Thi H-N, Minh Le AD, Gia Nguyen BD, Tran-Thi H-N, et al. Evaluation of the impact before and after the application of an antimicrobial stewardship program at Dong Thap General Hospital, Vietnam, from 2017 to 2021. Infection Prevention in Practice. 2023; 5(4): 100311. doi: 10.1016/j.infpip.2023. 100311
  14. Kaiser RA, Taing L, Bhatia H. Antimicrobial resistance and environmental health: A water stewardship framework for global and national action. Antibiotics. 2022; 11(1): 63. doi: 10.3390/antibiotics11010063
  15. Khoa NT, Khue LN, Huong PLT. Situation of reasonable antibiotic use in Thai Binh and Nam Dinh General Hospitals in 2017. Vietnam Journal of Preventive Medicine. 2020; 30(7): 173-178. doi: 10.51403/0868-2836/ 2020/170
  16. Khoa NT, Khue LN, Huong PLT. Effectiveness of some interventions to increase the rational use of antibiotics at Thai Binh General Hospital, 2017-2019. Journal of Preventive Medicine. 2020; 30(7): 179-186. doi: 10.51403/ 0868-2836/2020/171
  17. Schweickert B, Feig M, Schneider M, Willrich N, Behnke M, Peña Diaz LA, et al. Antibiotic consumption in Germany: first data of a newly implemented web-based tool for local and national surveillance. The Journal of Antimicrobial Chemotherapy. 2018; 73(12): 3505-3515. doi: 10.1093/jac/dky345
  18. Hou J, Long X, Wang X, Li L, Mao D, Luo Y, et al. Global trend of antimicrobial resistance in common bacterial pathogens in response to antibiotic consumption. Journal of Hazardous Materials. 2023; 442: 130042. doi: 10.1016/j.jhazmat.2022.130042
  19. Wade T, Roberts N, Ban JW, Waweru-Siika W, Winston H, Williams V, et al. Utility of healthcare-worker-targeted antimicrobial stewardship interventions in hospitals of low- and lower-middle-income countries: A scoping review of systematic reviews. Journal of Hospital Infection. 2023; 131: 43-53. doi: 10.1016/j.jhin.2022. 09.008
  20. Sharland M, Gandra S, Huttner B, Moja L, Pulcini C, Zeng M, et al. Encouraging awareness and discouraging inappropriate antibiotic use-the new 2019 Essential Medicines List becomes a global antibiotic stewardship tool. The Lancet Infectious Diseases. 2019; 19(12): 1278-12780. doi: 10.1016/s1473-3099(19)30532-8
  21. Sharland M, Zanichelli V, Ombajo LA, Bazira J, Cappello B, Chitatanga R, et al. The WHO Essential Medicines List AWaRe book: from a list to a quality improvement system. Clinical microbiology and infection: The official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2022; 28(12): 1533-1535. doi: 10.1016/j.cmi.2022.08.009
  22. Huttner B, Saam M, Moja L, Mah K, Sprenger M, Harbarth S, et al. How to improve antibiotic awareness campaigns: findings of a WHO global survey. BMJ Global Health. 2019; 4(3): e001239. doi: 10.1136/bmjgh-2018-001239
  23. Correia S, Poeta P, Hébraud M, Capelo JL, Igrejas G. Mechanisms of quinolone action and resistance: where do we stand? Journal of Medical Microbiology. 2017; 66(5): 551-5519. doi: 10.1099/jmm.0.000475
  24. Crayton E, Richardson M, Fuller C, Smith C, Liu S, Forbes G, et al. Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review. BMC Geriatrics. 2020; 20(1): 237. doi: 10.1186/s12877-020-01564-1
  25. Klein EY, Milkowska-Shibata M, Tseng KK, Sharland M, Gandra S, Pulcini C, et al. Assessment of WHO antibiotic consumption and access targets in 76 countries, 2000-15: an analysis of pharmaceutical sales data. The Lancet Infectious Diseases. 2021; 21(1): 107-115. doi: 10.1016/S1473-3099(20)30332-7
  26. Sherif FM (2022) Education and practice of pharmacy in Libya. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2022; 2(3): 1-2. doi: 10.5281/zenodo.7115078
  27. Mahjoub AA, Elshwehdi AM, Bakeer AM. Effect of antimicrobial susceptibility testing on treating Libyan outpatients with a suspected bacterial infection. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2024; 4(3): 41-50. doi: 10.5281/zenodo.13630840

Submitted date:
06/03/2025

Reviewed date:
07/02/2025

Accepted date:
07/11/2025

Publication date:
08/01/2025

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