Optimizing surgical antimicrobial prophylaxis through clinical pharmacist-led audit and feedback: Evidence from a Vietnamese tertiary hospital

The inappropriate use of surgical antibiotic prophylaxis (SAP) remains a common issue in Vietnam, posing a significant risk of surgical site infections (SSIs) and other adverse outcomes. This study aimed to evaluate the impact of a pharmacist-led audit-feedback (A&F) intervention, as part of an antimicrobial stewardship (AMS) program, on improving compliance with SAP guidelines. A prospective pre-post interventional study was conducted in the surgical departments of Saint Paul General Hospital. A multidisciplinary team, led primarily by clinical pharmacists, conducted audit-feedback activities on SAP practices from December 2023 to April 2024. The primary outcome was the overall compliance rate with SAP guidelines. Secondary outcomes included compliance with specific components: antibiotic selection, timing of administration, dosing, and duration of use. A total of 162 patients in the pre-intervention group and 147 in the post-intervention group were included. After two audit-feedback phases, overall compliance with SAP guidelines significantly increased from 60.49% to 76.87% (OR: 2.97, 95% CI: 1.71-5.28). Notably, the most significant improvements were observed in the appropriateness of antibiotic selection and duration of use, increasing from 74.69% to 88.44% (OR: 2.57, 95%CI: 1.40-4.89) and 72.84% to 88.44% (OR: 2.82, 95% CI: 1.55-5.36), respectively. Conclusion, the audit-feedback intervention led by clinical pharmacists substantially improved compliance with SAP guidelines across several domains. This study provides pragmatic evidence from a tertiary hospital in Vietnam, demonstrating that audit-feedback is not only feasible but also impactful in resource-limited settings. Importantly, this approach could inform scalable AMS and infection prevention policies in other low-and middle-income countries.