{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T01:35:11Z","timestamp":1785116111788,"version":"3.55.0"},"reference-count":22,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Merck Sharp & Dohme","award":["MISP 102061"],"award-info":[{"award-number":["MISP 102061"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,16]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to assess the impact of clinical pharmacist-led antimicrobial stewardship on antibiotic use and postoperative pulmonary infection in a surgical department.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective and cross-sectional.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A tertiary hospital in Wuhan, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 9157 patients who underwent video-assisted thoracoscopic lung surgery (VATLS) were included (4949 and 4208 pre-implementation and post-implementation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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 \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      test, Fisher\u2019s exact test, t-test or Mann-Whitney U test, as appropriate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Following implementation, antibiotic use intensity decreased immediately by 96.65 defined daily doses\/100 bed-days (95%\u2009CI \u2212122.56 to \u221270.74; p&lt;0.001). Antibiotic spectrum coverage (ASC) also showed an immediate reduction of 4.77 scores\/100 bed-days (95%\u2009CI \u22126.12 to \u22123.42; p&lt;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&lt;0.001), while usage of fourth-generation cephalosporins (12.3% to 1.5%), \u03b2-lactam\/\u03b2-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&lt;0.05). The median duration of antimicrobial therapy was shortened across most antibiotic classes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107282","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T15:50:19Z","timestamp":1775577019000},"page":"e107282","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["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"],"prefix":"10.1136","volume":"16","author":[{"given":"Guangjie","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuying","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Infection Management, The People\u2019s Hospital of Lincang, Lincang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"He","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Information, Zhujiang Hospital of Southern Medical University, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2793-6402","authenticated-orcid":false,"given":"Xiaoxv","family":"Yin","sequence":"additional","affiliation":[{"name":"Tongji Medical College, School of Public Health, Department of Social Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, 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