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Vu HTL, Pham TTT, Duong YH, Truong QA, Nguyen HK, Nguyen TTC, Trinh LX, Nguyen HTH, Le MQ, Vu VH, Chau DM, Huynh NT, Vo ETHD, Le HNM, Pham TN, Pollack TM, Van Doorn HR. Antibiotic prescribing practices of medical doctors in a resource-limited setting and the influence of individual perceptions and stewardship support: a survey in three tertiary hospitals in Vietnam. JAC Antimicrob Resist 2024; 6:dlae064. [PMID: 38633223 PMCID: PMC11022071 DOI: 10.1093/jacamr/dlae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
Objectives To understand antibiotic prescribing and influencing factors to inform antimicrobial stewardship (AMS) interventions to reduce unwanted consequences of antibiotic use in hospitals in Vietnam, a lower-middle-income country in Asia. Methods We conducted a cross-sectional study of doctors at three tertiary hospitals using non-probability convenience sampling, through a paper-based (Hospitals 1 and 2) or electronic (Hospital 3) survey. Questions included items on perceptions regarding antibiotic resistance and AMS, prescribing practices, knowledge, demographics and training. We used principal components analysis and mixed-effects models to examine practices and identify influencing factors. Results Among 314 surveyed participants, 61%, 57% and 59% in Hospitals 1, 2 and 3, respectively, felt certain about the appropriateness of their antibiotic prescriptions. In total, 9% reported sometimes prescribing antibiotics when not needed to meet patients' expectations, and 13% reported doing so to avoid perceived complications. Higher prescribing confidence was found among those with positive perceptions about AMS (P < 0.0001), whereas negative perceptions about colleagues' practices reduced this confidence (P < 0.0001). Individual preference for branded antibiotics was associated with more unnecessary prescribing whereas having higher prescribing confidence decreased the habits of prescribing when not needed. Conclusions This study provides important implications for design of hospital interventions to address influencing factors on antibiotic prescribing in Vietnam and similar resource-limited settings. Specific interventions should target improving knowledge through education and training for doctors, enhancing the support from the AMS team, and promoting guidelines and policies for appropriate antibiotic use in hospital.
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Affiliation(s)
- Huong Thi Lan Vu
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
| | - Thuy Thi Thanh Pham
- Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, Hanoi, Vietnam
| | - Yen Hai Duong
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
| | - Quan Anh Truong
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
| | - Hong Khanh Nguyen
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
| | - Tu Thi Cam Nguyen
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
| | - Long Xuan Trinh
- Vietnam National Children’s Hospital, 18/879 La Thanh, Dong Da, Hanoi, Vietnam
| | - Ha Thi Hong Nguyen
- Vietnam National Children’s Hospital, 18/879 La Thanh, Dong Da, Hanoi, Vietnam
| | - Minh Quang Le
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Vietnam
| | - Vinh Hai Vu
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Vietnam
| | - Duc Minh Chau
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh, Dong Thap, Vietnam
| | - Nguyet Thi Huynh
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh, Dong Thap, Vietnam
| | | | | | - Thach Ngoc Pham
- National Hospital for Tropical Diseases, 78 Giai Phong, Hanoi, Vietnam
| | - Todd M Pollack
- Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, Hanoi, Vietnam
| | - H Rogier Van Doorn
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Hasegawa S, Harris CM, Gupta V, Pappas M, Vaughn VM, Perencevich EN, Dukes KC, Goto M. Clinicians' interpretation of thresholds in hospital antibiograms for gram-negative rod infections: A survey and contingent valuation study of hospitalists. J Hosp Med 2024; 19:297-301. [PMID: 38353153 DOI: 10.1002/jhm.13303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 04/04/2024]
Abstract
Clinical guidelines suggest that hospital antibiograms are a key component when deciding empiric therapy, but little is known about how often clinicians use antibiograms and how they influence clinicians' empiric therapy decisions. We surveyed hospitalists at seven healthcare systems in the United States on their reported practices related to antibiograms and their hypothetical prescribing for four clinical scenarios associated with gram-negative rod pathogens. Each was given a randomly assigned antibiogram susceptibility percentage, and we used contingent valuation analysis to assess whether the antibiogram susceptibility percentage was associated with prescribing practices. Of the 193 survey responders, only 52 (26.9%) respondents reported using antibiograms more than monthly. Across all four clinical scenarios, there was no evidence that antibiogram susceptibility levels influenced antibiotic prescribing practices. With limited utilization and no evidence that they influenced practice, antibiograms may have a limited role in hospitalist care delivery for common gram-negative rod infections.
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Affiliation(s)
- Shinya Hasegawa
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Che M Harris
- Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Vineet Gupta
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Matthew Pappas
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Valerie M Vaughn
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Eli N Perencevich
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Kimberly C Dukes
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Michihiko Goto
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
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3
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Ngan TTD, Quan TA, Quang LM, Vinh VH, Duc CM, Nguyet HT, Tu NTC, Khanh NH, Long LB, Hue NH, Hung DT, Thanh ND, Ve NV, Giang TT, Tung LT, Tuan TT, Kesteman T, Dodds Ashley E, Anderson DJ, Van Doorn HR, Huong VTL. Review of antibiotic prescriptions as part of antimicrobial stewardship programmes: results from a pilot implementation at two provincial-level hospitals in Viet Nam. JAC Antimicrob Resist 2023; 5:dlac144. [PMID: 36686271 PMCID: PMC9847554 DOI: 10.1093/jacamr/dlac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives To investigate the feasibility of retrospective prescription-based review and to describe the antibiotic prescribing patterns to provide information for an antimicrobial stewardship programme in Viet Nam. Methods This study was conducted in two provincial-level hospitals between February and April 2020. Reviews were done by a clinical team consisting of leaders/senior doctors of each ward to assess the optimal level (optimal/adequate/suboptimal/inadequate/not assessable) of antibiotic prescriptions. Mixed-effect logistic regression at prescription level was used to explore factors associated with optimal antibiotic use. Results The retrospective prescription-based review was accepted by study clinical wards with varied levels of participants. One hundred and eighty-three patients (326 prescriptions) in Hospital 1 and 200 patients (344 prescriptions) in Hospital 2 were included. One hundred and nineteen of the 326 (36.5%) antibiotic prescriptions in Hospital 1 and 51/344 (14.8%) antibiotic prescriptions in Hospital 2 were determined to be optimal by the review teams. The number of adequate antibiotic prescriptions were 179/326 (54.9%) and 178 (51.7%) in Hospital 1 and Hospital 2, respectively. The optimal level was lower for surgical prophylaxis antibiotics than for empirical therapy (OR = 0.06; 95% CI 0.01-0.45), higher in prescriptions in the ICU (OR = 12.00; 95% CI 3.52-40.92), higher in definitive antibiotic therapy (OR = 48.12; 95% CI 7.17-322.57) and higher in those with an indication recorded in medical records (OR = 3.46; 95% CI 1.13-10.62). Conclusions This study provides evidence on the feasibility of retrospective prescription-based review, with adaption to the local situation. High and varying levels of optimal antibiotic prescriptions in clinical wards in hospitals were observed in Viet Nam.
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Affiliation(s)
- Ta Thi Dieu Ngan
- National Hospital for Tropical Diseases, 78 Giai Phong, Hanoi, Viet Nam
- Hanoi Medical University, 1 Ton That Tung, Hanoi, Viet Nam
| | - Truong Anh Quan
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
| | - Le Minh Quang
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Vu Hai Vinh
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Chau Minh Duc
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Huynh Thi Nguyet
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Nguyen Thi Cam Tu
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
| | - Nguyen Hong Khanh
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
| | - Le Ba Long
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Nguyen Hong Hue
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Dinh The Hung
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Nguyen Duc Thanh
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Nguyen Van Ve
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Tran Thanh Giang
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Le Thanh Tung
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Truong Thanh Tuan
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Thomas Kesteman
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
| | - Elizabeth Dodds Ashley
- Duke Antimicrobial Stewardship Outreach Network, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, NC 27710, USA
| | - Deverick J Anderson
- Duke Antimicrobial Stewardship Outreach Network, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, NC 27710, USA
| | - H Rogier Van Doorn
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Vu Thi Lan Huong
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
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Hamada S, Tokuda Y, Honda H, Watari T, Suzuki T, Moromizato T, Narita M, Taniguchi K, Shibuya K. Prevalence and characteristics of antibiotic prescription for acute COVID-19 patients in Japan. Sci Rep 2022; 12:22340. [PMID: 36572705 PMCID: PMC9791152 DOI: 10.1038/s41598-022-26780-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
COVID-19 is a viral infection and does not require antibiotics. The study aimed to elucidate a prescribing pattern of antibiotics for COVID-19. A nationwide cross-sectional study was conducted in Japan. The Diagnosis and Procedure Combinations (DPC) data was used to collect information, covering 25% of all acute care hospitals in the country. In 140,439 COVID-19 patients, 18,550 (13.21%) patients received antibiotics. Antibiotics were prescribed more often in inpatients (10,809 out of 66,912, 16.15%) than outpatients (7741 out of 73,527, 10.53%) (p < 0.001). Outpatient prescription was significantly associated with older patients (odds ratio [OR], 4.66; 95% confidence interval [CI] 4.41-4.93) and a greater Charlson index (OR with one-point index increase, 1.22; 95% CI 1.21-1.23). Inpatient prescription was significantly associated with older patients (OR 2.10; 95% CI 2.01-2.21), male gender (OR 1.12, 95% CI 1.07-1.18), a greater Charlson index (OR with one-point increase, 1.06; 95% CI 1.05-1.07), requirement of oxygen therapy (OR 3.44; 95% CI 3.28-3.60) and mechanical ventilation (OR 15.09; 95% CI 13.60-16.74). The most frequently prescribed antibiotic among outpatients was cefazolin, while that among inpatients was ceftriaxone. Antibiotic prescription is relatively low for acute COVID-19 in Japan. Antibiotic prescription was associated with older age, multi-morbidity, severe disease, and winter season.
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Affiliation(s)
| | - Yasuharu Tokuda
- The Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan ,grid.513068.9Muribushi Okinawa Center for Teaching Hospitals, 3-42-8 Iso, Urasoe, Okinawa 901-2132 Japan ,grid.20515.330000 0001 2369 4728University of Tsukuba School of Medicine, Tsukuba, Japan
| | | | - Takashi Watari
- grid.411621.10000 0000 8661 1590General Medicine Center, Shimane University, Matsue, Shimane Japan
| | | | - Takuhiro Moromizato
- Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Haebaru, Okinawa Japan
| | - Masashi Narita
- Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Haebaru, Okinawa Japan
| | - Kiyosu Taniguchi
- The Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan ,grid.415573.10000 0004 0621 2362National Hospital Organization Mie National Hospital, Tsu, Mie Japan
| | - Kenji Shibuya
- The Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan
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Economos ET, Goedken CC, Sherlock SH, Suda KJ, Goetz M, Balkenende E, Chasco EE, Scherer AM, Goto M, Perencevich EN, Schacht Reisinger H, Livorsi DJ. Investigation of factors influencing inpatient antibiotic prescribing decisions in the Veterans' Health Administration. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e99. [PMID: 36483404 PMCID: PMC9726494 DOI: 10.1017/ash.2022.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 06/17/2023]
Abstract
To investigate factors that influence antibiotic prescribing decisions, we interviewed 49 antibiotic stewardship champions and stakeholders across 15 hospitals. We conducted thematic analysis and subcoding of decisional factors. We identified 31 factors that influence antibiotic prescribing decisions. These factors may help stewardship programs identify educational targets and design more effective interventions.
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Affiliation(s)
| | - Cassie Cunningham Goedken
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Stacey Hockett Sherlock
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Katie J. Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew Goetz
- VA Greater Los Angeles Healthcare System, Los Angeles, California
- David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California
| | - Erin Balkenende
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Emily E. Chasco
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Aaron M. Scherer
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Michihiko Goto
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Eli N. Perencevich
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Heather Schacht Reisinger
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Daniel J. Livorsi
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
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Dat VQ, Dat TT, Hieu VQ, Giang KB, Otsu S. Antibiotic use for empirical therapy in the critical care units in primary and secondary hospitals in Vietnam: a multicenter cross-sectional study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100306. [PMID: 35024650 PMCID: PMC8669321 DOI: 10.1016/j.lanwpc.2021.100306] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 12/23/2022]
Abstract
Background The high rate of infections among patients admitted to critical care units (CCUs) is associated with high rate of antibiotic consumption, especially broad-spectrum antibiotics. This study is to describe the antibiotics use in CCUs in primary and secondary hospitals in Vietnam, a setting with high burden of antibiotic resistance. Methods This was a 7-day observational study in 51 CCUs in hospitals from 5 provinces in Vietnam from March to July 2019. Patients aged ≥ 18 years admitted to the participating CCUs was enrolled consecutively. We collected data on patient's demographics, initial diagnosis and antibiotic therapy within the first 24 hours. Antibiotic therapy was classified by the Anatomical Therapeutic Chemical (ATC) Index and the 2019 WHO Access, Watch, Reserve (AWaRe) groups. Findings Out of 1747 enrolled patients, empirical antibiotic treatments were initiated in 1112 (63.6%) patients. The most frequently prescribed antibiotics were cefotaxime (22.3%), levofloxacin (19%) and ceftazidime (10.8%). Antibiotics were given in 31.5% of patients without diagnosis of infection. Watch and/or Reserve group antibiotic were given in 87.3% of patients and associated with patient's age (aOR 1.01 per 1-year increment, 95%CI 1.00-1.02) and the presence of SIRS on admission (aOR 2.1, 95%CI 1.38-3.2). Interpretation We observed a high frequency use and a substantial variation in patterns of empirical antibiotic use in the CCUs in Vietnam. It highlights the importance of continuous monitoring antibiotic consumption in CCUs.
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Affiliation(s)
- Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam (No 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam).,Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam (No 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam)
| | - Tran Tat Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam (No 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam)
| | - Vu Quang Hieu
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam (No 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam)
| | - Kim Bao Giang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam (No 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam)
| | - Satoko Otsu
- World Health Organisation Viet Nam Country Office, Hanoi, VietNam (304 Kim Ma Street, Hanoi, VietNam).,Infectious Disease Department, Japanese Red Cross Wakayama Medical Centre, Wakayama City, Wakayama, Japan (4-20 Komatsubara-dori, Wakayama City 640-8558, Wakayama, Japan)
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Interplay between Phenotypic Resistance to Relevant Antibiotics in Gram-Negative Urinary Pathogens: A Data-Driven Analysis of 10 Years' Worth of Antibiogram Data. Life (Basel) 2021; 11:life11101059. [PMID: 34685429 PMCID: PMC8537761 DOI: 10.3390/life11101059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 12/18/2022] Open
Abstract
The global emergence of antimicrobial resistance (AMR) has become a critical issue for clinicians, as it puts the decades of developments in the medical field in jeopardy, by severely limiting the useful therapeutic arsenal of drugs, both in nosocomial and community-acquired infections. In the present study, a secondary analysis of taxonomic and resistance data was performed, corresponding to urinary tract infections (UTIs) caused by Gram-negative bacteria, detected between 1 January 2008 to 31 December 2017 at the Albert Szent-Györgyi Health Center, University of Szeged. The following were identifiable from the data collected: year of isolation; outpatient (OP)/inpatient (IP) origin of the isolate; taxonomy; and susceptibility/resistance to selected indicator antibiotics. Principal component analysis (PCA) and a correlation matrix were used to determine the association between the presences of resistance against indicator antibiotics in each taxonomic group. Overall, data from n = 16,240 outpatient and n = 13,964 inpatient Gram-negative UTI isolates were included in the data analyses. In E. coli, strong positive correlations were seen between resistance to ciprofloxacin (CIP) and gentamicin (GEN) resistance (OP: r = 0.6342, p = 0.049; IP: r = 0.9602, p < 0.001), whereas strong negative correlations were shown for fosfomycin (FOS) and nitrofurantoin (NIT) resistance (OP: r = -0.7183, p = 0.019; IP: r = -0.7437; p = 0.014). For Klebsiella spp. isolates, CIP resistance showed strong positive correlation with resistance to third-generation cephalosporins (3GC) and GEN (r = 0.7976, p = 0.006 and r = 0.7428, p = 0.014, respectively) in OP isolates, and with resistance to trimethoprim-sulfamethoxazole (SXT) and FOS (r = 0.8144, p = 0.004 and r = 0.7758, p < 0.001, respectively) in IP isolates. For members of the Citrobacter-Enterobacter-Serratia group, the resistance among indicator antibiotics showed a strong positive correlation, with the exception of FOS resistance. In the Proteus-Providencia-Morganella group, the strongest association was noted between CIP and SXT resistance (OP: r = 0.9251, p < 0.001; IP: r = 0.8007; p = 0.005). In the case of OP Acinetobacter spp., CIP showed strong and significant positive correlations with most indicator antibiotics, whereas for IP isolates, strong negative correlations arose among imipenem (IMI) resistance and resistance to other drugs. For Pseudomonas spp., strong and positive correlations were noted among resistance to β-lactam antibiotics and aminoglycosides, with the exception of ceftazidime (CEFT), showing strong, but negative correlations. Though molecular tests and sequencing-based platforms are now considered as the gold-standard for AMR surveillance, standardized collection of phenotypic resistance data and the introduction of Big Data analytic methods may be a viable alternative for molecular surveillance, especially in low-resource settings.
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8
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Nguyen LV, Pham LTT, Bui AL, Vi MT, Nguyen NK, Le TT, Pham ST, Nguyen PM, Nguyen TH, Taxis K, Nguyen T, Tran HD. Appropriate Antibiotic Use and Associated Factors in Vietnamese Outpatients. Healthcare (Basel) 2021; 9:healthcare9060693. [PMID: 34201175 PMCID: PMC8228789 DOI: 10.3390/healthcare9060693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 01/21/2023] Open
Abstract
Background: Inappropriate antibiotic use among outpatients is recognized as the primary driver of antibiotic resistance. A proper understanding of appropriate antibiotic usage and associated factors helps to determine and limit inappropriateness. We aimed to identify the rate of appropriate use of antibiotics and identify factors associated with the inappropriate prescriptions. Methods: We conducted a cross-sectional descriptive study in outpatient antibiotic use at a hospital in Can Tho City, Vietnam, from August 1, 2019, to January 31, 2020. Data were extracted from all outpatient prescriptions at the Medical Examination Department and analyzed by SPSS 18 and Chi-squared tests, with 95% confidence intervals. The rationale for antibiotic use was evaluated through antibiotic selection, dose, dosing frequency, dosing time, interactions between antibiotics and other drugs, and general appropriate usage. Results: A total of 420 prescriptions were 51.7% for females, 61.7% with health insurance, and 44.0% for patients with one comorbid condition. The general appropriate antibiotic usage rate was 86.7%. Prescriptions showed that 11.0% and 9.5% had a higher dosing frequency and dose than recommended, respectively; 10.2% had an inappropriate dosing time; 3.1% had drug interactions; and only 1.7% had been prescribed inappropriate antibiotics. The risk of inappropriate antibiotic use increased in patients with comorbidities and antibiotic treatment lasting >7 days (p < 0.05). Conclusions: The study indicated a need for more consideration when prescribing antibiotics to patients with comorbidities or using more than 7 days of treatment.
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Affiliation(s)
- Lam V. Nguyen
- Department of Anatomy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam;
| | - Lien T. T. Pham
- Department of Medicinal Chemistry, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam;
| | - Anh L. Bui
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam; (A.L.B.); (M.T.V.); (N.K.N.); (S.T.P.); (T.N.)
| | - Mai T. Vi
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam; (A.L.B.); (M.T.V.); (N.K.N.); (S.T.P.); (T.N.)
| | - Nguyet K. Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam; (A.L.B.); (M.T.V.); (N.K.N.); (S.T.P.); (T.N.)
| | - Tam T. Le
- Can Tho University of Medicine and Pharmacy Hospital, Can Tho City 900000, Vietnam;
| | - Suol T. Pham
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam; (A.L.B.); (M.T.V.); (N.K.N.); (S.T.P.); (T.N.)
| | - Phuong M. Nguyen
- Department of Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam;
| | - Thao H. Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam;
| | - Katja Taxis
- Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands;
| | - Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam; (A.L.B.); (M.T.V.); (N.K.N.); (S.T.P.); (T.N.)
| | - Hung D. Tran
- Faculty of Nursing, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
- Correspondence:
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Godman B, Egwuenu A, Haque M, Malande OO, Schellack N, Kumar S, Saleem Z, Sneddon J, Hoxha I, Islam S, Mwita J, do Nascimento RCRM, Dias Godói IP, Niba LL, Amu AA, Acolatse J, Incoom R, Sefah IA, Opanga S, Kurdi A, Chikowe I, Khuluza F, Kibuule D, Ogunleye OO, Olalekan A, Markovic-Pekovic V, Meyer JC, Alfadl A, Phuong TNT, Kalungia AC, Campbell S, Pisana A, Wale J, Seaton RA. Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries. Life (Basel) 2021; 11:life11060528. [PMID: 34200116 PMCID: PMC8229985 DOI: 10.3390/life11060528] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
- School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang 11800, Malaysia
- Correspondence: ; Tel.: +44-0141-548-3825; Fax: +44-0141-552-2562
| | - Abiodun Egwuenu
- AMR Programme Manager, Nigeria Centre for Disease Control (NCDC), Ebitu Ukiwe Street, Jabi, Abuja 240102, Nigeria;
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia;
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, P.O. Box 536, Egerton 20115, Kenya;
- East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda
| | - Natalie Schellack
- Faculty of Health Sciences, Basic Medical Sciences Building, University of Pretoria, Prinshof 349-Jr, Pretoria 0084, South Africa;
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India;
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan;
| | - Jacqueline Sneddon
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1005 Tirana, Albania;
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh;
| | - Julius Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0022, Gaborone, Botswana;
| | - Renata Cristina Rezende Macedo do Nascimento
- Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Ouro Preto 35400-000, Minas Gerais, Brazil;
| | - Isabella Piassi Dias Godói
- Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá 68500-00, Pará, Brazil;
- Center for Research in Management, Society and Epidemiology, Universidade do Estado de Minas Gerais, Belo Horizonte 31270-901, MT, Brazil
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda P.O Box 5175, Cameroon;
- Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H101, Eswatini;
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Israel Abebrese Sefah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana;
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya;
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
| | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek 13301, Namibia;
| | - Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria;
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos 100271, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos 100271, Nigeria;
- Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos 100271, Nigeria
| | - Vanda Markovic-Pekovic
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
| | - Abubakr Alfadl
- National Medicines and Poisons Board, Federal Ministry of Health, Khartoum 11111, Sudan;
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56264, Qassim 56453, Saudi Arabia
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, Vietnam;
| | - Aubrey C. Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 32379, Lusaka 10101, Zambia;
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK;
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Janney Wale
- Independent Researcher, 11a Lydia Street, Brunswick, VIC 3056, Australia;
| | - R. Andrew Seaton
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
- Infectious Disease Department, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
- Department of Medicine, University of Glasgow, Glasgow G12 8QQ, UK
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Do NTT, Li R, Dinh HTT, Nguyen HTL, Dao MQ, Nghiem TNM, Nadjm B, Luong KN, Cao TH, Le DTK, Cluzeau F, Ngo CQ, Chu HT, Vu DQ, van Doorn HR, Roberts CM. Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam. JAC Antimicrob Resist 2021; 3:dlab040. [PMID: 34046595 PMCID: PMC8127081 DOI: 10.1093/jacamr/dlab040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/05/2021] [Indexed: 01/13/2023] Open
Abstract
Objectives To test the effectiveness of a quality improvement programme to promote adherence to national quality standards (QS) for patients hospitalized with community-acquired pneumonia (CAP), exploring the factors that hindered improvements in clinical practice. Methods An improvement bundle aligned to the QS was deployed using plan-do-study-act methodology in a 600 bed hospital in northern Vietnam from July 2018 to April 2019. Proposed care improvements included CURB65 score guided hospitalization, timely diagnosis and inpatient antibiotic treatment review to limit the spectrum and duration of IV antibiotic use. Interviews with medical staff were conducted to better understand the barriers for QS implementation. Results The study found that improvements were made in CURB65 score documentation and radiology results available within 4 h (P < 0.05). There were no significant changes in the other elements of the QS studied. We documented institutional barriers relating to the health reimbursement mechanism and staff cultural barriers relating to acceptance and belief as significant impediments to implementation of the standards. Conclusions Interventions led to some process changes, but these were not utilized by clinicians to improve patient management. Institutional and behavioural barriers documented may inhibit wider national uptake of the QS. National system changes with longer term support and investment to address local behavioural barriers are likely to be crucial for future improvements in the management of CAP, and potentially other hospitalized conditions, in Vietnam.
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Affiliation(s)
- Nga T T Do
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Ryan Li
- Global Health and Development Group, Imperial College London, London, UK
| | | | | | | | | | - Behzad Nadjm
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,University College London Hospitals NHS Foundation Trust, London, UK.,Clinical Services Department, MRC Unit The Gambia at The London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Khue N Luong
- Medical Services Administration, Ministry of Health, Hanoi, Vietnam
| | - Thai H Cao
- Medical Services Administration, Ministry of Health, Hanoi, Vietnam
| | - Dung T K Le
- Medical Services Administration, Ministry of Health, Hanoi, Vietnam
| | - Francoise Cluzeau
- Global Health and Development Group, Imperial College London, London, UK
| | | | | | - Dat Q Vu
- Hanoi Medical University, Hanoi, Vietnam.,National Hospital of Tropical Diseases, Hanoi, Vietnam
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - C Michael Roberts
- Essex Partnership University NHS Trust, Wickford, UK.,UCL Partners, London, UK.,Royal College of Physicians, London, UK
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