Impact of Antimicrobial Stewardship Program on Vancomycin Usage: Costs and Outcomes at Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam

Abstract

Background Nowadays, with the emergence of vancomycin-resistant strains, the clinical use of vancomycin has been followed closely by applying the antimicrobial stewardship program (ASP) to enhance effectiveness in treatment and reduce cost burden for patients. Methods A descriptive cross-sectional study at the Hospital for Tropical Diseases was conducted to assess the inpatient status assigned to intravenous vancomycin and factors associated with the cost of treatment during two periods of implementing ASP, which were i) from April 1, 2016 to March 31, 2018 (previous ASP-pASP) and ii) from June 1, 2018 to March 31, 2020 (new ASP-nASP). Results Among 1375 patients who met the sampling criteria, there were 601 and 774 patients in pASP and nASP, respectively. The rate of no improvement/mortality in the pASP was higher than that in nASP (37.10% vs 25.98%, p <0.05). The proportion of patients with two or more infection episodes in nASP is lower than that in pASP (9.83% vs 18.64%, p<0.05). Besides, nASP has higher length of therapy (LOT) and higher day of therapy (DOT). The average treatment cost in the pASP is higher than that in the nASP, 1891.22 (95% CI, 1713.46–2068.98) USD vs 1775.55 (95% CI, 1576.22–1974.88) USD. There are seven factors (p<0.05) that associate with the total cost of treatment (age, number of infection episodes, length of stay, discharge status, clinical department, LOT, DOT) in pASP. On the other hand, the nASP has five factors (p<0.001), in which the log(LOT) and age are not as statistically significant (p=0.5127 and 0.3852, respectively) as in the pASP model. Conclusion The implementation and improvement of the ASP at the Hospital for Tropical Diseases have initially shown benefits for patients using intravenous vancomycin. Specifically, the ASP helps to reduce treatment costs, improve patient outcomes, reduce length of stay and decrease the average daily dose of vancomycin.

Effectiveness of an enhanced antibiotic stewardship programme among paediatric patients in a tertiary hospital in Vietnam

“…In addition, the Access-to-Watch ratio statistically significantly increased before and after the enhanced ASP (RR without seasonal adjustment: 1.90, 95%CI: 1.52-2.37; RR with seasonal adjustment: 1.73, 95%CI: 1.38-2.17) (Figure 3). The Hospital for Tropical Diseases in Ho Chi Minh City was one of the earliest introducers of an ASP in practice following the call from The Vietnam Ministry of Health in 2016 [10]. At the end of 2017, the hospital ASP team found no improvement in antibiotic prescribing and patient outcomes despite the high rate of guideline adherence, and decided to use further measures to improve the ASP.…”

“…Previous studies have reported a significant impact of paediatric ASPs on improving clinical outcomes and tackling AMR [8,9]. In March 2016, the Vietnamese Ministry of Health issued Decision 772 to guide the establishment of an ASP in hospital settings [10]. In April 2016, the first ASP was established at the Hospital for Tropical Diseases in Ho Chi Minh City, one of the largest tertiary hospitals specializing in infectious diseases treatment in Vietnam.…”

Estimation of Prevalence of Hospital-Acquired Blood Infections among Patients Admitted at a Tertiary Hospital in Oman over a Period of Five Years: A Cross-Sectional Study

“…A general analysis strategy has been formulated to follow which was described by Alsumait et al [26] and Nguyen [27]. Te prevalence of HA-BSI in patients was calculated by dividing the number of HA-BSI cases by the total admission.…”

Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae: Risk Factors and Economic Burden Among Patients with Bloodstream Infections

“…We advocate for a more rigorous implementation of the WHO's ESBL detection tricycle plan and the AWaRe tool, along with the establishment of multi-dimensional molecular epidemiological surveillance and robust antimicrobial stewardship programs, to address the complex, multidisciplinary challenge posed by antimicrobial resistance. [38][39][40][41] Despite controlling for various confounders, potential selection biases in our study cannot be entirely ruled out. To optimize patient inclusion in the PSM, we did not factor in individual comorbidities, given the varying weights assigned to diseases in the Charlson score.…”