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

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.