Optimising perioperative antimicrobial stewardship for Class I incisions: a clinical pharmacist-led multidisciplinary...

Appropriate prophylactic antimicrobial use in Class I (clean) incision surgery is crucial for patient safety and combating resistance. Although guidelines discourage routine prophylaxis, overuse remains prevalent. This study evaluated the effectiveness of a clinical pharmacist-led, multimodal antimicrobial stewardship programme (ASP) in optimising perioperative antimicrobial use for Class I incision surgeries.

A single-centre, quasi-experimental study with a historical control design was conducted. Consecutive patients undergoing Class I incision surgery were included in pre-intervention (September 2024-February 2025) and post-intervention (March 2025-August 2025) groups. The intervention comprised four components: (1) formation of a multidisciplinary ASP team led by clinical pharmacists, (2) embedding pharmacists within surgical departments for real-time stewardship, (3) implementation of standardised training and protocols, and (4) deployment of an informatised monitoring and performance feedback system. Primary outcomes were prophylactic antimicrobial use rate, appropriate drug selection rate, and average duration of prophylaxis. Secondary outcomes included appropriate timing and duration rates, surgical site infection (SSI) rate, antimicrobial cost, length of stay, and adverse drug reactions.

A total of 824 patients in the pre-intervention group and 997 patients in the post-intervention group were included. Prophylactic antimicrobial use decreased significantly from 51.21% to 30.79% (P<0.001). Appropriate drug selection improved from 88.74% to 96.96% (P<0.001), and average prophylaxis duration decreased from 3.0 to 1.2 days (P<0.001). The SSI rate remained stable (0.97% vs. 0.70%, P = 0.623). Significant improvements were observed in appropriate timing (94.60% to 99.70%, P<0.001) and duration rates (96.41% to 98.19%, P = 0.042), along with reductions in per capita antimicrobial cost (320 RMB to 150 RMB, P<0.001), length of stay (2.5 days to 1.8 days, P<0.001), and antimicrobial-related adverse reactions (1.09% to 0.40%, P = 0.037).

A clinical pharmacist-led multimodal ASP intervention significantly improved the appropriate use of perioperative antimicrobial prophylaxis for Class I incision surgeries, reducing unnecessary use and costs without increasing SSI risk. This approach represents an effective and replicable stewardship model for routine surgical care.