Longitudinal analysis of antimicrobial consumption and economic outcomes of surgical prophylaxis stewardship in a wartime Ukrainian maternity hospital

Abstract Objective: To analyze the dynamics of antimicrobial consumption and evaluate the clinical and economic outcomes of a comprehensive antimicrobial stewardship (AMS) program in a Ukrainian maternity hospital. Design: Retrospective observational study. Methods: The study was conducted at a tertiary referral maternity hospital in Kyiv, Ukraine, using two datasets. First, a longitudinal analysis of pharmacy dispensing records (2020–2024) was performed to assess consumption trends. Second, a comparative cohort analysis of 320 women undergoing gynecological surgery (preAMS [2018] vs postAMS [2023]; n = 160 per group) was conducted to evaluate the impact of stewardship interventions. The AMS program, implemented in 2020, utilized administrative “stop-orders” for postoperative prophylaxis and pharmacy gatekeeping for broad-spectrum agents. Economic outcomes were assessed using a patient-level micro-costing approach. Results: A profound structural shift occurred: consumption of ceftriaxone decreased from 72.4% of total prophylactic units in 2020 to 1.4% in 2024, replaced by cefazolin (0% to 44.0%). In the clinical cohorts, unjustified postoperative antibiotic use was eliminated (46.3% in 2018 to 0% in 2023; P < .001). The transition to single-dose prophylaxis reduced the mean direct antibiotic cost by 78.4% and coincided with a decrease in the mean length of stay from 9.85 to 4.68 days ( P < .001). The program generated an estimated net saving of approximately $1,040 per surgical case. Conclusions: Institution-level stewardship interventions successfully shifted prescribing toward guideline-concordant use and generated substantial cost savings. This study demonstrates the resilience and feasibility of low-cost stewardship models in high-pressure, transitional healthcare environments.