How often did carbapenem prescribing and antibiotic preauthorization follow hospital guidance at a national hospital in Vietnam?

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Carbapenems are broad-spectrum antibiotics used as last-line treatment for severe drug-resistant infections, but resistance to them is increasing. Thong Nhat Hospital, a national hospital in Vietnam, implemented preauthorization for some restricted antibiotics, including carbapenems, to optimize their use in patients. This study investigated the hospital's current carbapenem use and preauthorization.

This descriptive cross-sectional study examined medical records of inpatients with at least one carbapenem order form at Thong Nhat Hospital from December 2023 to February 2024. Data collected for analysis covered microbiological features, carbapenem resistance patterns, characteristics of carbapenem use and preauthorization, and treatment outcomes. The study included 348 patients, whose median age was 69 years.

Escherichia coli was the most frequently isolated Gram-negative bacterium, while Acinetobacter baumannii had the lowest susceptibility to carbapenems. The proportion of carbapenem regimens considered appropriate under hospital guidelines was 68.10%. Dose optimization was the most common intervention during preauthorization. For 73.28% of patients, the preauthorization process for all restricted antimicrobials complied with the hospital protocol.

A high Charlson score and diagnoses of septic shock, respiratory tract infection, and central nervous system infection were associated with lower treatment success. The authors concluded that carbapenem preauthorization should be strengthened to optimize appropriate use, particularly in patients with multiple comorbidities and severe infections.