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

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. 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. 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. 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). 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.