PHARMACIST-LED PERIOPERATIVE ANTIMICROBIAL STEWARDSHIP AND SURGICAL SITE INFECTION REDUCTION

Abstract

Surgical site infections (SSIs) represent a significant global burden, leading to substantial patient morbidity, mortality, and staggering economic costs on healthcare systems worldwide. Traditional approaches to surgical antimicrobial prophylaxis (SAP), while foundational to modern surgery, are frequently suboptimal in their application and contribute to the escalating crisis of antimicrobial resistance (AMR). This review synthesizes the extensive body of evidence supporting a targeted, high-impact model of care: pharmacist-led perioperative antimicrobial stewardship (AMS). This model is predicated on the clinical pharmacist's unique and profound expertise in clinical pharmacology, pharmacokinetics, pharmacodynamics, and medication systems to optimize every critical facet of SAP, from agent selection to discontinuation. Central to the success of this model is the synergistic and indispensable partnership between the clinical pharmacist and the infection prevention and control (IPC) team. IPC surveillance data—including SSI rates, pathogen trends, and local antibiograms—provides the critical feedback loop that informs, validates, and continuously refines pharmacist-led interventions, creating a dynamic engine for quality improvement. A robust and growing body of literature, including systematic reviews and meta-analyses, demonstrates that this collaborative approach significantly improves adherence to evidence-based guidelines for antimicrobial selection, timing, and duration; substantially reduces SSI rates; decreases overall antimicrobial consumption and associated healthcare costs; and critically mitigates the selective pressure driving AMR . The integration of a dedicated clinical pharmacist into the perioperative workflow, working in close collaboration with IPC, is therefore no longer a niche or optional service but a cornerstone of modern, safe, and effective surgical care. This review provides a comprehensive, evidence-based roadmap for its scientific rationale, practical implementation, and systematic evaluation.