Optimising perioperative antimicrobial stewardship for Class I incisions: a clinical pharmacist-led multidisciplinary intervention and outcomes

Background: 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. Methods: 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. Results: 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