Doshi Jaslyn, Ngoc Yen Pham, Ma Thu Thuy, Duong Linh Thuy, Pham Van Thi Thuy, Vu Van Giap, James Rodney, Li Qingbin, Van Quy Trinh, Nguyen Tu Son, Tran Thi Thu Trang, Vo Pham Minh Thu, Ngo Van An, Phan Huu Phuc, Hoang Ngoc Canh, Beardsley Justin, Nguyen Thu Anh, Fox Greg J
Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
The University of Sydney Vietnam Institute, Hanoi, Vietnam.
Lancet Reg Health West Pac. 2025 Jul 10;60:101620. doi: 10.1016/j.lanwpc.2025.101620. eCollection 2025 Jul.
BACKGROUND: Inappropriate antimicrobial use is a key driver of antimicrobial resistance. Antimicrobial stewardship (AMS) promotes the judicious use of antimicrobials to address this problem. This study evaluated the effect of an AMS program on antimicrobial prescribing practices in district hospitals in Vietnam. METHODS: A cluster randomised controlled trial was conducted in 16 district hospitals in northern and southern Vietnam over four months. Hospitals were randomly assigned to intervention or control groups. Interventions included establishing AMS committees and teams, distributing antimicrobial guidelines, training healthcare workers, providing patient educational material, and conducting periodic audits with feedback on antimicrobial prescribing. Co-primary outcomes were the "difference in differences" in (i) total antimicrobial consumption and (ii) inappropriate prescribing according to standardised guidelines, before and after the intervention, between intervention and control groups. Secondary outcomes included antimicrobial costs and all-cause mortality. After the intervention period, control sites also received the AMS program. Trial registry: Australia and New Zealand Clinical Trials Registry (ANZCTR) number 12622000715774. FINDINGS: A total of 877 and 1220 antimicrobial prescriptions were reviewed in intervention hospitals, and 1277 and 1454 prescriptions in control hospitals at baseline and post-intervention. Inappropriate antimicrobial prescribing exceeded 60% in each hospital at baseline. After the intervention, inappropriate prescribing in the intervention group reduced by 6.3% (95% CI -10.9%, -1.7%) relative to the control group. Total antimicrobial consumption did not differ between groups, but antimicrobial costs reduced in the intervention group. No difference in all-cause mortality was observed. INTERPRETATION: AMS interventions modestly reduced inappropriate antimicrobial prescribing in district hospitals in Vietnam, underscoring the importance of AMS in resource-limited settings. FUNDING: The Australian Department of Foreign Affairs and Trade.
背景：抗菌药物的不当使用是导致抗菌药物耐药性的关键因素。抗菌药物管理（AMS）旨在促进抗菌药物的合理使用以解决这一问题。本研究评估了一项AMS计划对越南地区医院抗菌药物处方行为的影响。 方法：在越南北部和南部的16家地区医院进行了一项为期四个月的整群随机对照试验。医院被随机分配到干预组或对照组。干预措施包括成立AMS委员会和团队、分发抗菌药物指南、培训医护人员、提供患者教育材料以及定期进行审核并反馈抗菌药物处方情况。共同主要结局是干预组与对照组在干预前后（i）抗菌药物总消耗量和（ii）根据标准化指南判断的不当处方的“差值差异”。次要结局包括抗菌药物成本和全因死亡率。干预期结束后，对照组医院也接受了AMS计划。试验注册：澳大利亚和新西兰临床试验注册中心（ANZCTR）编号12622000715774。 结果：在基线期和干预期后，干预组医院分别审查了877张和1220张抗菌药物处方，对照组医院分别审查了1277张和1454张处方。每家医院在基线期不当抗菌药物处方均超过60%。干预后，干预组的不当处方相对于对照组减少了6.3%（95%CI -10.9%，-1.7%）。两组间抗菌药物总消耗量无差异，但干预组的抗菌药物成本降低。未观察到全因死亡率有差异。 解读：AMS干预措施适度降低了越南地区医院不当抗菌药物处方率，凸显了AMS在资源有限环境中的重要性。 资助：澳大利亚外交与贸易部。
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