ArticleBMJ open2026
Impact of a clinical pharmacist-led stewardship programme on antibiotic utilisation and clinical outcomes in thoracic surgery: a retrospective interrupted time-series study at a tertiary hospital in China.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study aims to assess the impact of clinical pharmacist-led antimicrobial stewardship on antibiotic use and postoperative pulmonary infection in a surgical department.
designRetrospective and cross-sectional.
settingA tertiary hospital in Wuhan, China.
participantsA total of 9157 patients who underwent video-assisted thoracoscopic lung surgery (VATLS) were included (4949 and 4208 pre-implementation and post-implementation).
methodsAn 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 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.
resultsFollowing 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.
conclusionClinical 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.
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