Context-Specific Impact Of Antimicrobial Stewardship On Antibiotic Use And Antibiotic Resistance In Hospitals In A Lower-Middle Income Country - Results From Implementation Study With A Controlled Interrupted Time Series Design In Vietnam
AIM: We aim to identify the impact of an antimicrobial stewardship (AMS) intervention, which includes pharmacist-led prospective audit with feedback, on hospital antibiotic use and resistance in two provincial-level general hospitals in Vietnam. BACKGROUND: Quality evidence on the impact of AMS is l...
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Elsevier
2024-12-01
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| Series: | Journal of Global Antimicrobial Resistance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716524002546 |
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| author | Trang Quynh Le Dung Tien Viet Vu Quang Minh Le Huyen Thi Thu Nguyen Vinh Hai Vu Duc Minh Chau Em Thi Hoang Dung Vo Tu Thi Cam Nguyen Quan Anh Truong Khanh Hong Nguyen Hoa Nguyen Minh Le Thomas Kesteman Elizabeth Dodds Ashley Deverick J. Anderson Hugo C. Turner Thach Ngoc Pham Ben S. Cooper Choisy Marc H Rogier Van Doorn Huong Thi Lan Vu |
| author_facet | Trang Quynh Le Dung Tien Viet Vu Quang Minh Le Huyen Thi Thu Nguyen Vinh Hai Vu Duc Minh Chau Em Thi Hoang Dung Vo Tu Thi Cam Nguyen Quan Anh Truong Khanh Hong Nguyen Hoa Nguyen Minh Le Thomas Kesteman Elizabeth Dodds Ashley Deverick J. Anderson Hugo C. Turner Thach Ngoc Pham Ben S. Cooper Choisy Marc H Rogier Van Doorn Huong Thi Lan Vu |
| author_sort | Trang Quynh Le |
| collection | DOAJ |
| description | AIM: We aim to identify the impact of an antimicrobial stewardship (AMS) intervention, which includes pharmacist-led prospective audit with feedback, on hospital antibiotic use and resistance in two provincial-level general hospitals in Vietnam. BACKGROUND: Quality evidence on the impact of AMS is limited in Asia and often lacks of control group, resulting in biased outcomes. METHODS: We performed interrupted time-series (ITS) and controlled ITS (CITS) analyses to evaluate the impact of AMS intervention on antibiotic use in days of therapy per 1000 patient-days (DOT1000) and antibiotic non-susceptibility (NS) among hospital-acquired isolates. In each hospital, four wards received the intervention and four wards served as controls. Pre-intervention periods spanned from January 2019 to May 2020 (hospital 1) and June 2020 (hospital 2), followed by a 12-month post-intervention period (Figure 1). RESULTS: In hospital 1, a consistent significant reduction in average DOT1000 by 95.9 (CITS 95%CI [10.9, 180.8]) was observed; although both models showed inconsistent effects on slope. In hospital 2, DOT1000 showed inconsistent patterns on both level and slope. Both hospitals show inconsistent impact on AMR, particularly hospital 2 showed a reduction in average in antibiotic NS among Klebsiella spp. to ciprofloxacin, slopes in P. aeruginosa to carbapenem and ciprofloxacin. In contrast, hospital 1 have increasing level in Klebsiella spp. NS to carbapenems (Figure 2). CONCLUSIONS: The AMS impact varied between two hospitals, highlighting the context-specific implementation challenges and the need to monitor antibiotic use and resistance patterns over time to tailor interventions to the local context. |
| format | Article |
| id | doaj-art-c7a64224efbe487e91995f07d345cce0 |
| institution | DOAJ |
| issn | 2213-7165 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj-art-c7a64224efbe487e91995f07d345cce02025-08-20T02:53:16ZengElsevierJournal of Global Antimicrobial Resistance2213-71652024-12-01392510.1016/j.jgar.2024.10.077Context-Specific Impact Of Antimicrobial Stewardship On Antibiotic Use And Antibiotic Resistance In Hospitals In A Lower-Middle Income Country - Results From Implementation Study With A Controlled Interrupted Time Series Design In VietnamTrang Quynh Le0Dung Tien Viet Vu1Quang Minh Le2Huyen Thi Thu Nguyen3Vinh Hai Vu4Duc Minh Chau5Em Thi Hoang Dung Vo6Tu Thi Cam Nguyen7Quan Anh Truong8Khanh Hong Nguyen9Hoa Nguyen Minh Le10Thomas Kesteman11Elizabeth Dodds Ashley12Deverick J. Anderson13Hugo C. Turner14Thach Ngoc Pham15Ben S. Cooper16Choisy Marc17H Rogier Van Doorn18Huong Thi Lan Vu19Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet NamOxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet NamViet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet NamViet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet NamViet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet NamDong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong ThapDong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong ThapOxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet NamOxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet NamOxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet NamNational Hospital for Tropical Diseases, 78 Giai Phong, Hanoi, Viet NamOxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet NamDuke Antimicrobial Stewardship Outreach Network, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, NC 27710, United StatesDuke Antimicrobial Stewardship Outreach Network, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, NC 27710, United StatesMRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UKNational Hospital for Tropical Diseases, 78 Giai Phong, Hanoi, Viet NamCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UKOxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet NamOxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet NamOxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet NamAIM: We aim to identify the impact of an antimicrobial stewardship (AMS) intervention, which includes pharmacist-led prospective audit with feedback, on hospital antibiotic use and resistance in two provincial-level general hospitals in Vietnam. BACKGROUND: Quality evidence on the impact of AMS is limited in Asia and often lacks of control group, resulting in biased outcomes. METHODS: We performed interrupted time-series (ITS) and controlled ITS (CITS) analyses to evaluate the impact of AMS intervention on antibiotic use in days of therapy per 1000 patient-days (DOT1000) and antibiotic non-susceptibility (NS) among hospital-acquired isolates. In each hospital, four wards received the intervention and four wards served as controls. Pre-intervention periods spanned from January 2019 to May 2020 (hospital 1) and June 2020 (hospital 2), followed by a 12-month post-intervention period (Figure 1). RESULTS: In hospital 1, a consistent significant reduction in average DOT1000 by 95.9 (CITS 95%CI [10.9, 180.8]) was observed; although both models showed inconsistent effects on slope. In hospital 2, DOT1000 showed inconsistent patterns on both level and slope. Both hospitals show inconsistent impact on AMR, particularly hospital 2 showed a reduction in average in antibiotic NS among Klebsiella spp. to ciprofloxacin, slopes in P. aeruginosa to carbapenem and ciprofloxacin. In contrast, hospital 1 have increasing level in Klebsiella spp. NS to carbapenems (Figure 2). CONCLUSIONS: The AMS impact varied between two hospitals, highlighting the context-specific implementation challenges and the need to monitor antibiotic use and resistance patterns over time to tailor interventions to the local context.http://www.sciencedirect.com/science/article/pii/S2213716524002546Antimicrobial stewardshipinterrupted time seriescontrolled interrupted time serieshospital acquired isolateslow-middle income country |
| spellingShingle | Trang Quynh Le Dung Tien Viet Vu Quang Minh Le Huyen Thi Thu Nguyen Vinh Hai Vu Duc Minh Chau Em Thi Hoang Dung Vo Tu Thi Cam Nguyen Quan Anh Truong Khanh Hong Nguyen Hoa Nguyen Minh Le Thomas Kesteman Elizabeth Dodds Ashley Deverick J. Anderson Hugo C. Turner Thach Ngoc Pham Ben S. Cooper Choisy Marc H Rogier Van Doorn Huong Thi Lan Vu Context-Specific Impact Of Antimicrobial Stewardship On Antibiotic Use And Antibiotic Resistance In Hospitals In A Lower-Middle Income Country - Results From Implementation Study With A Controlled Interrupted Time Series Design In Vietnam Journal of Global Antimicrobial Resistance Antimicrobial stewardship interrupted time series controlled interrupted time series hospital acquired isolates low-middle income country |
| title | Context-Specific Impact Of Antimicrobial Stewardship On Antibiotic Use And Antibiotic Resistance In Hospitals In A Lower-Middle Income Country - Results From Implementation Study With A Controlled Interrupted Time Series Design In Vietnam |
| title_full | Context-Specific Impact Of Antimicrobial Stewardship On Antibiotic Use And Antibiotic Resistance In Hospitals In A Lower-Middle Income Country - Results From Implementation Study With A Controlled Interrupted Time Series Design In Vietnam |
| title_fullStr | Context-Specific Impact Of Antimicrobial Stewardship On Antibiotic Use And Antibiotic Resistance In Hospitals In A Lower-Middle Income Country - Results From Implementation Study With A Controlled Interrupted Time Series Design In Vietnam |
| title_full_unstemmed | Context-Specific Impact Of Antimicrobial Stewardship On Antibiotic Use And Antibiotic Resistance In Hospitals In A Lower-Middle Income Country - Results From Implementation Study With A Controlled Interrupted Time Series Design In Vietnam |
| title_short | Context-Specific Impact Of Antimicrobial Stewardship On Antibiotic Use And Antibiotic Resistance In Hospitals In A Lower-Middle Income Country - Results From Implementation Study With A Controlled Interrupted Time Series Design In Vietnam |
| title_sort | context specific impact of antimicrobial stewardship on antibiotic use and antibiotic resistance in hospitals in a lower middle income country results from implementation study with a controlled interrupted time series design in vietnam |
| topic | Antimicrobial stewardship interrupted time series controlled interrupted time series hospital acquired isolates low-middle income country |
| url | http://www.sciencedirect.com/science/article/pii/S2213716524002546 |
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