Combating Antimicrobial Resistance: A Pharmacist-Led PDCA Stewardship Program in a Tertiary Hospital

Antimicrobial resistance (AMR) is a critical global health threat driven by inappropriate antimicrobial use. Reducing antimicrobial consumption and optimizing prescribing are fundamental goals of Antimicrobial Stewardship Programs (ASPs). This study aimed to implement and evaluate a pharmacist-led, multidimensional ASP based on the Plan-Do-Check-Act (PDCA) cycle to reduce Antibacterial Use Density (AUD) and improve prescribing quality.

A quasi-experimental study was conducted from October 2023 to September 2024 in a tertiary hospital. Led by a multidisciplinary ASP team and guided by the PDCA cycle, the intervention comprised: 1) an innovative "1+X" ward-based clinical pharmacist model to standardize surgical antimicrobial prophylaxis (SAP); 2) promoting precision diagnostics via Therapeutic Drug Monitoring (TDM) and droplet digital PCR (ddPCR); 3) establishing regular multidisciplinary case discussions; and 4) integrating informatics-driven alerts into the prescribing system. Data on AUD, SAP quality, diagnostic utilization, and cost were extracted from the hospital information system and analyzed.

Hospital-wide AUD significantly decreased by 25.06%, from 49.68 to 37.23 DDDs/100 patient-days (p<0.001). A resource-concentrating strategy led to greater AUD reduction in six high-consumption medical departments than in others (23.26 vs. 5.17 DDDs/100 patient-days, p<0.05). The "1+X" model improved duration rationality for Type I incisions from 50.54% to 78.44% (p<0.001). TDM utilization increased 7.7-fold, and ddPCR showed rapid clinical adoption. Access antibiotic use increased nearly five-fold. Total antimicrobial cost decreased by 7.8%.

A pharmacist-led, PDCA-based ASP integrating differentiated strategies and precision diagnostics effectively reduced antimicrobial consumption, optimized prescribing structure, improved SAP quality, and generated economic benefits. This model provides a replicable framework for sustainable antimicrobial stewardship in hospitals.