Improving antimicrobial use through antimicrobial stewardship in a lower-middle income setting: a mixed-methods study in a network of acute-care hospitals in Viet Nam.

Abstract Objectives This study aimed to analyze the current state of antimicrobial stewardship (AMS) in hospitals in Viet Nam, a lower middle-income country, to identify factors determining success in AMS implementation and associated challenges to inform planning and design of future programs. Methods We conducted a mixed-methods study in seven acute-care hospitals in the antimicrobial resistance (AMR) surveillance network in Viet Nam. Data collection included seven focus-group discussions, forty in-depth interviews and a self-administered quantitative survey of staff on AMR and AMS programs. We summarized qualitative data by reporting the most common themes according to the core AMS elements and analyzed quantitative data using proportions and a linear mixed-effects model. Results The findings reveal a complex picture of factors and actors involved in the AMS implementation from the national level to the departmental and individual level within each hospital. The level of implementation varied, starting from the formation of an AMS committee and with or without an active delivery of specific interventions. Development of treatment guidelines, pre-authorization of antimicrobial drug classes, and post-prescription audit and feedback to doctors at selected clinical departments were the main interventions reported. A higher level of leadership support and commitment to AMS led to a higher level of engagement with AMS activities from the AMS team and effective collaboration between departments involved. Conclusions Establishing country-specific guidelines on AMS staffing and adapting standards for AMS education and training from international resources are needed to support capacity building to implement AMS programs effectively in LMICs like Viet Nam.