Vu Thi Lan Huong: Antimicrobial stewardship

My name is Vu Thi Lan Huong. I'm a senior research fellow at OUCRU Hanoi. My research focuses on antimicrobial resistance, particularly the spread of gram-negative bacteria that are resistant to antibiotics in healthcare settings, and also the public health intervention to control this in Asia.

My goal is to understand how resistance develops and spreads, and evaluate and improve the effectiveness of interventions in hospitals, particularly in resource-limited environments. Our aim is to support the strategies that can mitigate the impact of antimicrobial resistance and improve patients’ outcomes.

At OUCRU Hanoi, we have been actively working on antimicrobial stewardship interventions aiming to improve antibiotic use in hospitals. In this programme, we combine strategies to alter prescribers’ behaviour with the hope that we can prevent bacteria from developing resistance to multiple antibiotics, which is a very serious and common issue in hospital settings, particularly in low- and middle-income countries like Vietnam.

The objective of our programme of stewardship interventions is to reduce the overuse of antibiotics and thereby stopping bacteria from developing resistance to antibiotics in hospitals, and from there stopping them spreading into the wider community. One significant impact of our stewardship intervention is to enhance hospital safety and protect patients. Our activities are dedicated to ensuring that hospitals do not become breeding grounds for multidrug resistant bacteria, and protecting individual patients from acquiring unnecessary and potentially life-threatening infections in hospitals. By curbing the proliferation and development of antibiotic resistant bacteria in hospital settings, we are not only protecting patients in the hospital from acquiring hospital-acquired infections, but we also prevent the spread of antimicrobial resistance into the wider community. That is a very important aspect of our missions.

One significant challenge in our work is the lack of microbiological and genomic-level data, because of insufficient facilities in low- and middle-income countries like Vietnam. This hinders our ability to understand fully the impact of stewardship programmes, the impact of antibiotic use on the development and transmission of bacteria resistant to antibiotics. To address this, we will conduct further studies and apply different methods, to have more robust data to support our analyses in collaboration with other groups in Ho Chi Minh City and external collaborations.

We've seen concrete successes of our intervention studies. For example, in early studies we conducted interventions at two provincial hospitals, and we devised protocols for pharmacists to review prescription of antibiotics and provide recommendations and feedback to doctors. We provided them with opportunities to learn from experienced leaders internationally and locally. Upon returning to the institutions, they began to review their prescriptions and provide feedback to the doctors. Over time when we monitor this, they managed to perform over 1,000 reviews per year at the medical trust for patients and provided feedback and recommendations to doctors in addition to their routine activities, which is a good sign because this integration into the routine will ensure the sustainability of this intervention in the long term. We’ve also seen a positive impact on prescribing behaviours among doctors and especially the reduction in antibiotics in certain areas.

Policy engagement is a very important component to increase the impact of our intervention on stewardship programmes in hospitals. Back in 2018 when we first took the baseline assessment, we started to engage policy makers by organising a national level stakeholder meeting with participants from a variety of partners, including the Ministry of Health, the One Health Organisation, hospitals and health departments, and from other private sectors as well. This provided an excellent opportunity for us to start talking about the interventions in stewardship programmes. Up until now, we continue our efforts on policy engagement by organising a second workshop in 2023. We aim to continue this policy engagement efforts to have our findings from research to become critical evidence that is readily accessible for the governments, in order to make decisions. That will amplify the impact of our research on antimicrobial stewardship practice.

This interview was recorded in January 2024.