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Reducing the spread of superbugs in Vietnam

November 4, 2022 by Shivani Dhebar (Intern), Nga Nguyen Quynh (Program Officer), and Linda Venczel (Program Director, Epidemic Preparedness and Response)

PATH, the US Centers for Disease Control and Prevention, and Hue Central Hospital in Vietnam are working together to control the growing threat of antimicrobial resistance.

Pharmacist Hoang Thanh Nga assists a customer in Hanoi. Photo: PATH/Matthew Dakin.

Pharmacist Hoang Thanh Nga assists a customer in Hanoi. In 2018, PATH partnered with physicians and pharmacists in Vietnam to address antimicrobial resistance. Photo: PATH/Matthew Dakin.

In recent years, antimicrobial resistance (AMR) has become a top global cause of death. More than 1.27 million deaths were associated with bacterial AMR in 2019, with the highest disease burden occurring in low-resource settings.

As more resistant pathogens emerge, they can multiply and spread quickly to other individuals and communities, making it difficult for health care professionals to clear common infections.

AMR tends to spread more rapidly in environments where antibiotics are excessively prescribed, and often in the absence of essential health care resources such as vaccines and diagnostic equipment.

The COVID-19 pandemic has accelerated the need to control the spread of superbugs. In July 2022, the US Centers for Disease Control and Prevention (CDC) reported a substantial increase in superbug infections due to overwhelmed hospital systems, ineffective antibiotic treatment regimens, longer hospital stays, and increased medical interventions (such as catheters, ventilators, and other supportive devices).

Monitoring antibiotic usage to manage AMR

In 2018, as part of its quality improvement program, Hue Central Hospital in Vietnam teamed up with PATH, the US CDC, and local pharmacists to set up an antimicrobial stewardship program for monitoring antibiotic use.

Pharmacists were enlisted to review the medical charts of patients in the intensive care unit and provide recommendations to physicians on whether to continue, increase, or decrease antibiotic dosage. PATH worked closely with the partners to review data to modify the interventions as needed.

By 2019, the stewardship program achieved success, with 160 medical records reviewed and 169 recommendations made to physicians. The overall frequency of antibiotic prescriptions decreased by 24 percent, measured in days of therapy—a common measure used to determine the effectiveness of antimicrobial stewardship programs—per 1,000 patient-days between 2018 and 2019.

Infographic courtesy of Hue Central Hospital.

After implementing an antimicrobial stewardship program at Hue Central Hospital, the average monthly days of therapy per 1,000 patient-days decreased among all types of antibiotics. Infographic courtesy of Hue Central Hospital.

“With recommendations from pharmacists, physicians were able to prescribe antibiotics more judiciously,” says Dr. Nguyen Quynh Nga, Program Officer at PATH. “Over time, these efforts to improve antibiotic stewardship will curb the spread of antimicrobial resistance.”

“With recommendations from pharmacists, physicians were able to prescribe antibiotics more judiciously. Over time, these efforts to improve antibiotic stewardship will curb the spread of antimicrobial resistance.”
— Dr. Nguyen Quynh Nga, Program Officer, PATH

Strengthening surveillance for antibiotic resistance

Since 2017, PATH has been working with the Vietnam Ministry of Health and the US CDC to enhance digital AMR surveillance reporting. To date, PATH has supported 16 different surveillance sites in Vietnam to detect and report AMR and is currently supporting additional sites identified by the Vietnam Administration of Medical Services.

Now these surveillance systems are also being leveraged to measure the impact of antimicrobial stewardship programs.

Outside of Vietnam, PATH partners with national health systems in Kenya, Senegal, Tanzania, and Zambia to reduce the prevalence of AMR. PATH provides technical assistance for strengthening surveillance systems, improving routine reporting of AMR data, and enhancing microbiological capacity in laboratories.

The promising results from the antimicrobial stewardship program in Vietnam are just one part of PATH’s broader effort to curb the spread of AMR around the world.