Antibiotic resistance is currently one of the most serious global health challenges, reducing the effectiveness of treatment methods and increasing mortality rates. To cope with this situation, on December 31, 2020, the Ministry of Health issued Decision No. 5631/QĐ-BYT approving the document “Guidelines for implementing antibiotic use stewardship in hospitals”. One of the most important pillars of this guideline is the process of strictly monitoring antibiotic use and the antibiotic resistance situation at medical facilities.
The importance of surveillance activities
Surveillance activities do not stop at data collection but play a core role in evaluating the effectiveness of the antibiotic stewardship program. Through surveillance, hospitals can identify drug consumption trends, detect irrational prescribing issues, and grasp changes in pathogenic bacterial patterns. This is the evidence-based database for the Pharmacy and Therapeutics Committee to develop appropriate interventions, thereby improving patient care quality.
Surveillance of antibiotic use
According to Decision 5631/QĐ-BYT, antibiotic use surveillance needs to be carried out periodically and systematically. The goal is to measure antibiotic consumption and evaluate prescribing quality.
Regarding consumption surveillance, the unified recommended indicator is the Defined Daily Dose (DDD). To ensure accuracy and comparability, the DDD index needs to be adjusted per 100 or 1000 (patient-days or bed-days). The Clinical Pharmacy Unit is responsible for collecting data from pharmacy management software or medical records, then analyzing to compare usage trends between clinical departments, between different times, or with hospitals of the same rank. Besides DDD, the Days of Therapy (DOT) index is also encouraged if information technology conditions allow, helping to reflect patient antibiotic exposure more accurately.
Regarding prescribing quality surveillance, hospitals need to conduct cross-sectional surveys or retrospective/prospective medical record monitoring. Evaluation criteria include: adherence to treatment guidelines of the Ministry of Health or the hospital, rationality in selecting antibiotic type, dosage, route of administration, dosing interval, and treatment duration. Specifically, monitoring surgical prophylaxis antibiotic use needs to be focused on ensuring drugs are used at the right time and not prolonged beyond the prescribed time.
Surveillance of antibiotic resistance
Antibiotic resistance surveillance is a central task of the Microbiology Department in coordination with the Infection Control and Clinical Pharmacy units. Microbiology data needs to be aggregated to build the hospital’s antibiogram at least once a year.
Surveillance content includes monitoring the isolation rate of common pathogenic bacteria and their resistance rates to antibiotic groups. Especially, hospitals must strictly monitor multidrug-resistant organism (MDRO) strains such as Acinetobacter baumannii, Pseudomonas aeruginosa, ESBL-producing or carbapenem-resistant Enterobacteriaceae (CRE), and Methicillin-resistant Staphylococcus aureus (MRSA).
Antibiotic resistance surveillance results play a prerequisite role in building empirical treatment protocols at the hospital. When the antibiogram result is not yet available, clinicians will rely on this surveillance data to select the most appropriate initial antibiotic for the patient, increasing the success probability of treatment from the start and minimizing the risk of drug-resistant bacterial outbreaks.
Implementation organization and reporting
To make surveillance work effective, Decision 5631/QĐ-BYT requires close multidisciplinary coordination. The Antibiotic Stewardship Committee is responsible for directing implementation, in which the Pharmacy Department is the focal point for drug usage data and the Microbiology Department is the focal point for resistance data.
Surveillance reports need to be made periodically (quarterly or annually) and sent to the Pharmacy and Therapeutics Committee as well as the Board of Directors for timely adjustment directions. At the same time, feedback needs to be sent back to clinical departments so doctors understand the actual situation, thereby adjusting prescribing behavior towards safety and optimal effectiveness for patients.
MSc. Le Viet Anh – Deputy Director of the Center for Support & Continuing Education