Objective To investigate the use of prophylactic antibiotics for class Ⅰ surgical incisions during the perioperative period in secondary and tertiary traditional Chinese medicine (TCM) hospitals in Shanghai, and to provide a reference for promoting rational use of antibiotics.

Methods A retrospective study was conducted on the baseline information and data on perioperative use of prophylactic antibiotics for class Ⅰ surgical incision patient from 22 secondary and tertiary TCM hospitals in Shanghai between 2018 and 2023. Comprehensive analyses were performed on the types of antibiotics used, their rationality, and duration of postoperative administration.

Results A total of 51 694 cases of medication data from patients with class Ⅰ incision were collected. The rates of prophylactic use of antibiotics from 2018 to 2023 were 44.01% (3 638/8 268), 42.77% (4 114/9 619), 41.39% (3 466/8 373), 29.40% (3 619/12 311), 37.89% (2 244/5 923), and 36.26% (2 611/7 200), respectively. Stratified analyses showed that secondary integrated TCM-western medicine hospitals had the highest rates of prophylactic and postoperative antibiotic use, at 65.52% (1 357/2 071) and 63.16% (1 308/2 071), respectively. The rationality rate of preoperative antibiotic selection within 0.5‒1.0 h before surgery was 78.23% (3 456/4 418) in 2018‒2020, which increased to 80.93% (2 857/3 530) in 2021‒2023. The proportion of postoperative antibiotics use exceeding 72 h and 7 d showed a downward trend, but significant differences still existed among different categories of TCM hospitals (P<0.05).

Conclusion Overall, the prophylactic antibiotic use during the perioperative period for class Ⅰ surgical incisions in secondary and tertiary TCM hospitals in Shanghai has become increasingly standardized, yet instances of irrational use persist. Regulatory efforts should focus on strengthening supervision in TCM medical institutions, particularly regarding the use of antibiotics within 0.5 to 1 hour before surgery and postoperative use exceeding 7 days, as well as the perioperative prophylactic antibiotic use in secondary integrated TCM-western medicine hospitals, in order to further improve the rational application of prophylactic antibiotics.