Factors influencing choices of empirical antibiotic treatment for bacterial infections in a scenario-based survey in Vietnam. Issue 4 (10th November 2020)

• Record Type: Journal Article
• Authors: Vu, Thi Lan Huong; Vu, Quoc Dat; Hoang, Bao Long; Nguyen, Thi Cam Tu; Ta, Thi Dieu Ngan; Nadjm, Behzad; van Doorn, H Rogier
• Is Part Of: JAC-antimicrobial resistance. Volume 2:Issue 4(2020)
• Publication Date: 2020-11-10
• Subjects: Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; Drug resistance in microorganisms -- Periodicals; 616.9041
• DOI: 10.1093/jacamr/dlaa087
• Languages: English
• ISSNs: 2632-1823

Abstract

Abstract: Background: Antimicrobial stewardship (AMS) programmes have been implemented around the world to guide rational use of antibiotics but implementation is challenging, particularly in low- and middle-income countries, including Vietnam. Understanding factors influencing doctors' prescribing choices for empirical treatment can help design AMS interventions in these settings. Objectives: To understand doctors' choices of antibiotics for empirical treatment of common bacterial infections and the factors influencing decision-making. Methods: We conducted a cross-sectional survey among medical professionals applying for a postgraduate programme at Hanoi Medical University, Vietnam. We used a published survey developed for internal medicine doctors in Canada. The survey was self-administered and included four clinical scenarios: (i) severe undifferentiated sepsis; (ii) mild undifferentiated sepsis; (iii) severe genitourinary infection; and (iv) mild genitourinary infection. Results: A total of 1011/1280 (79%), 683/1188 (57.5%), 718/1157 (62.1%) and 542/1062 (51.0%) of the participants selected combination therapy for empirical treatment in scenarios 1, 2, 3 and 4, respectively. Undifferentiated sepsis (OR 1.82, 95% CI 1.46–2.27 and 2.18, 1.51–3.16 compared with genitourinary) and severe infection (1.33, 1.24–1.43 and 1.38, 1.21–1.58 compared with mild) increased the likelihood of choosing a combination therapy and a carbapenem regimen, respectively. Participants with higher acceptable minimum threshold for treatment coverage and young age were also more likely to prescribe carbapenems. Conclusions: Decision-making in antibiotic prescribing among doctors in Vietnam is influenced by both disease-related characteristics and individual factors, including acceptable minimum treatment coverage. These findings are useful for tailoring AMS implementation in Vietnam and other, similar settings.