Major article Antibiotic use in Vietnamese hospitals: A multicenter point-prevalence study Truong Anh Thu MD, MPH a, b, *, Mahbubur Rahman MD, PhD c , Susan Coffin MD, MPH d , Md. Harun-Or-Rashid MBBS, MS a , Junichi Sakamoto MD, PhD, FACS a , Nguyen Viet Hung MD, PhD b a Nagoya University Graduate School of Medicine, Young Leaders’ Program in Healthcare Administration, Nagoya, Japan b Department of Infection Control, Bach Mai Hospital, Hanoi, Vietnam c Center for Interdisciplinary Research in Women’s Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX d Division of Infectious Diseases, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA Key Words: Prescription Prevalence Indication Vietnam Background: Inappropriate antibiotic prescribing appears to be common worldwide and is contributing to the selection of resistant organisms. This study examined the prevalence of antibiotic prescription and the appropriateness of indications for these prescriptions in 36 representative general hospitals across Vietnam. Methods: A point-prevalence study was performed between February and December 2008. All inpatients on the day of the survey were included in the analysis. Standard published guidelines were used to evaluate the appropriateness of indications for antibiotic prescription. Results: On the day of the study, 5,104 of 7,571 patients (67.4%) were receiving antibiotic therapy. The antibiotic prescription rate was highest in surgery wards (93.2%) and lowest in medical wards (48.2%). Of the 5,104 patients receiving antibiotics, the most commonly prescribed agents were cephalosporins (70.2%), penicillins (21.6%), and aminoglycosides (18.9%). Approximately one-thirdof the patients (1,573 of 5,104) had an inappropriate indication for prescription. Risk factors independently associated with inappropriate indication for antibiotic prescription were seen in hospitals at the national level, obstetrics and gynecology departments, and surgical wards. Conclusions: Our data indicate a high rate of antibiotic use in Vietnamese hospitals, and also a high prevalence of inappropriate indications for antibiotic prescriptions. These findings suggest important areas for intervention and implementation of antibiotic stewardship policies in Vietnamese hospitals. Copyright Ó 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Antibiotics are among the most important advances in medical therapy over the past century. 1,2 They have dramatically changed the prognoses of patients with severe infectious diseases. 3,4 The success of antibiotic treatment has led to the excessive and indis- criminate use of antibiotics in hospitals worldwide. 3,5,6 Inappropriate use of antibiotics and poor infection prevention and control practices have provided favorable conditions for the development of many strains of resistant microorganisms. 7 The abundant literature is consistent regarding the concept of increasing resistance with increasing antibiotic use. 2,3,7,8 Although antibiotic resistance is rising, there are only a handful of new antibiotics currently in development, all of which are in early stages, with no new class of antibiotic expected to be ready for use in the next 20 years. 6 The emergence and dissemination of resistant organisms has increased the likelihood of antibiotic treatment failure and also increased the rate of adverse drug events. 1,3,4,8,9 Infections with antibiotic-resistant isolates pose a risk of health careeassociated spread of infectious pathogens and are associated with increased complications, elevated mortality, 1,3,4 and an increased financial burden to health care facilities, families, and society. 4,6,9 Thus, increasing antibiotic resistance is considered one of today’s most challenging problems in medical science, with clinical, economical, and public health implications. Although there is no lack of evidence-based guidelines for appropriate antibiotic use in devel- oping countries, previous studies suggest that up to 50% of antibiotic indications for hospitalized patients do not strictly adhere to these guidelines. 2,3,10 The impact of antibiotic resistance is far more serious in developing countries than in developed countries, with limited resources available to address the increasing frequency and magnitude of the problem. 11,12 Good antibiotic prescribing practice is the key to reducing the emergence of resistance and ensure the availability of drugs needed * Address correspondence to Truong Anh Thu, MD, MPH, Young Leaders’ Program in Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Nagoya 466-8550, Japan. E-mail address: truonganhthu2704@yahoo.com (T.A. Thu). Supported by research funds from the Vietnamese Ministry of Health. Conflict of interest: None to report. Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.ajic.2011.10.020 American Journal of Infection Control 40 (2012) 840-4