Optimizing antibiotic use for cesarean section in anticipation of the diagnosis-related groups payment system: a retrospective cohort study on the impact of clinical pharmacist intervention
- 1Department of Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092 China
- 2China Hospital Development Institute Shanghai Jiao Tong University, Shanghai, 200025 China
Abstract
Background: In anticipation of the nationwide implementation of the Diagnosis-Related Groups (DRG) 2.0 payment system in China, scheduled to take effect in 2025, hospitals are proactively seeking strategies to enhance care quality while optimizing resource utilization. Perioperative antibiotic stewardship for cesarean sections represents a key focus for these preparatory initiatives.
Objectives: To evaluate whether a structured clinical pharmacist-led intervention pathway, implemented in anticipation of the DRG payment reform, improves antibiotic appropriateness and reduces adverse outcomes and costs.
Methods: We conducted a retrospective cohort study involving 640 women who underwent cesarean section at a tertiary hospital. The control group (n = 314) received standard care (January–June 2024); the intervention group (n = 326) received care guided by a pharmacist-led pathway (July–December 2024), encompassing preoperative assessment, intraoperative support, and postoperative monitoring.
Results: The intervention significantly increased the rate of rational antibiotic use (94.8% vs. 89.2%, P = 0.009) and reduced postoperative infection rates (22.7% vs. 31.8%, P < 0.01). Multivariate analysis identified pharmacist intervention as an independent protective factor against infection (OR = 0.642, 95% CI: 0.449–0.918, P = 0.015). Additionally, the intervention group exhibited significantly lower total hospitalization costs, drug costs, and antibiotic costs (all P < 0.01).
Conclusion: In this real-world, before-and-after study, the implementation of a standardized clinical pharmacist-led antimicrobial stewardship pathway—anticipating China’s forthcoming DRG payment system— was associated with more rational antibiotic use, reduced postoperative infection rates, shorter hospital stays, and lower total costs among women undergoing cesarean sections. These findings underscore the potential value of integrating clinical pharmacists into perioperative care teams as a proactive, real-world strategy to enhance quality and efficiency in high-risk obstetric populations prior to the nationwide implementation of DRG.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13756-026-01789-6.
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BibTeX
@article{chen2026optimizing,
title = {{Optimizing antibiotic use for cesarean section in anticipation of the diagnosis-related groups payment system: a retrospective cohort study on the impact of clinical pharmacist intervention}},
author = {Ting Chen and Ranran Wang and Fenfen Gu and Jinlian Zhang and Chao Li and Lei Jin and Lixia Li},
journal = {Antimicrobial Resistance and Infection Control},
year = {2026},
month = jul,
doi = {10.1186/s13756-026-01789-6},
url = {https://doi.org/10.1186/s13756-026-01789-6},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Optimizing antibiotic use for cesarean section in anticipation of the diagnosis-related groups payment system: a retrospective cohort study on the impact of clinical pharmacist intervention
AU - Ting Chen
AU - Ranran Wang
AU - Fenfen Gu
AU - Jinlian Zhang
AU - Chao Li
AU - Lei Jin
AU - Lixia Li
PY - 2026
DA - 2026/07/10
JO - Antimicrobial Resistance and Infection Control
DO - 10.1186/s13756-026-01789-6
UR - https://doi.org/10.1186/s13756-026-01789-6
AB - Background: In anticipation of the nationwide implementation of the Diagnosis-Related Groups (DRG) 2.0 payment system in China, scheduled to take effect in 2025, hospitals are proactively seeking strategies to enhance care quality while optimizing resource utilization. Perioperative antibiotic stewardship for cesarean sections represents a key focus for these preparatory initiatives. Objectives: To evaluate whether a structured clinical pharmacist-led intervention pathway, implemented in anticipation of the DRG payment reform, improves antibiotic appropriateness and reduces adverse outcomes and costs. Methods: We conducted a retrospective cohort study involving 640 women who underwent cesarean section at a tertiary hospital. The control group (n = 314) received standard care (January–June 2024); the intervention group (n = 326) received care guided by a pharmacist-led pathway (July–December 2024), encompassing preoperative assessment, intraoperative support, and postoperative monitoring. Results: The intervention significantly increased the rate of rational antibiotic use (94.8% vs. 89.2%, P = 0.009) and reduced postoperative infection rates (22.7% vs. 31.8%, P < 0.01). Multivariate analysis identified pharmacist intervention as an independent protective factor against infection (OR = 0.642, 95% CI: 0.449–0.918, P = 0.015). Additionally, the intervention group exhibited significantly lower total hospitalization costs, drug costs, and antibiotic costs (all P < 0.01). Conclusion: In this real-world, before-and-after study, the implementation of a standardized clinical pharmacist-led antimicrobial stewardship pathway—anticipating China’s forthcoming DRG payment system— was associated with more rational antibiotic use, reduced postoperative infection rates, shorter hospital stays, and lower total costs among women undergoing cesarean sections. These findings underscore the potential value of integrating clinical pharmacists into perioperative care teams as a proactive, real-world strategy to enhance quality and efficiency in high-risk obstetric populations prior to the nationwide implementation of DRG. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13756-026-01789-6.
SN - 2047-2994
ER -