G. R. WU, Fuying Guo, Yan He, Jianhua Lu, Dong Liu, Xiaoxv Yin
Objectives This study aims to assess the impact of clinical pharmacist-led antimicrobial stewardship on antibiotic use and postoperative pulmonary infection in a surgical department. Design Retrospective and cross-sectional. Setting A tertiary hospital in Wuhan, China. Participants A total of 9157 patients who underwent video-assisted thoracoscopic lung surgery (VATLS) were included (4949 and 4208 pre-implementation and post-implementation). Methods An interrupted time-series design with segmented regression analysis was employed to evaluate changes in antibiotic use intensity (defined daily dose/100 bed-days), antibiotic spectrum coverage (scores/100 bed-days) and postoperative pulmonary infection rate before and after implementation of the stewardship programme. Between-group comparisons of antibiotic use rates and treatment duration were performed using χ 2 test, Fisher’s exact test, t-test or Mann-Whitney U test, as appropriate. Outcome measures Antibiotic use intensity (defined daily dose/100 bed-days), antibiotic spectrum coverage (scores/100 bed-days), postoperative pulmonary infection rates, the proportion and the duration of antibiotic use. Results Following implementation, antibiotic use intensity decreased immediately by 96.65 defined daily doses/100 bed-days (95% CI −122.56 to −70.74; p<0.001). Antibiotic spectrum coverage (ASC) also showed an immediate reduction of 4.77 scores/100 bed-days (95% CI −6.12 to −3.42; p<0.001), although a gradual upward trend in ASC was observed during the post-implementation period. No significant change was seen for postoperative pulmonary infection rates between the two periods. Prescribing patterns shifted towards narrower-spectrum agents: the proportion of first-generation cephalosporins increased from 17.6% to 45.5% (p<0.001), while usage of fourth-generation cephalosporins (12.3% to 1.5%), β-lactam/β-lactamase inhibitors (63.9% to 12.6%), quinolones (57.4% to 27.4%), carbapenems (0.8% to 0.4%) and glycopeptides (8.2% to 3.1%) declined significantly (all p<0.05). The median duration of antimicrobial therapy was shortened across most antibiotic classes. Conclusion Clinical pharmacist-led antimicrobial stewardship can reduce the antibiotic use intensity among patients undergoing VATLS in thoracic surgery, decrease the use of broad-spectrum antibiotics and shorten the duration of antibiotic therapy.