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Background and Importance Suboptimal anti-infective (AI) prescribing remains a critical driver of avoidable adverse events, antimicrobial resistance (AMR), and escalating healthcare costs–particularly due to prolonged hospital stays and overuse of broad-spectrum agents. To counter this, antibiotic stewardship (ABS) ward rounds have emerged as a cornerstone strategy for optimising AI prescriptions in hospital settings.Aim and Objectives This 12-month interventional study, conducted at University Hospital Freiburg, Germany, evaluated the impact of structured ABS ward rounds on prescription quality, frequency, and appropriateness in cardiovascular surgery.Material and Methods During weekly ward rounds on the cardiovascular surgery ward of a German university hospital, an interdisciplinary ABS team - comprising an ID specialist, clinical pharmacist, and microbiologist- reviews all AI-treated patients and advises the attending ward physicians on ABS-relevant patient cases. The recommended therapy optimisations are divided into six categories (de-escalation/therapy start, therapy duration/stop, oralisation, dosage, other, further recommendations). The measures implemented and the AIs affected are evaluated.Results Within one year (April 2024-March 2025), 430 AI consultations were conducted. The average number of AIs administered on the ward decreased from 36,1% to 18,4% per month. In July 2024, 10.56% of all patients received piperacillin/tazobactam, dropping to 1.72% by March 2025; cotrimoxazole fell from 8.07% to 1.15%, and meropenem from 4.35% to 0.63%.Most recommendations targeted ‘de-escalation/start of therapy,’ ‘therapy duration/stop,’ and ‘further recommendations.’. Notably, recommendations on therapy duration decreased from 3.11% to 1.89% and end of therapy fell from 2.48% to 0.57%. The frequency of the recommendation for an infectious disease consultation varied over time. Overall, the implementation rate of recommendations is consistently high at over 75%, demonstrating strong ward adherence.Conclusion and Relevance Considerable potential for improvement in AI prescriptions was identified on the visited ward, especially regarding diagnostics, infection confirmations and treatment duration. Ward rounds had a demonstrable effect on prescribing practices: Prescription frequency and structure improved, and, over time, the need for recommendations by the ABS team decreased. It was also found that a change of personnel within the ABS team can impact the type of recommendations made. ABS ward rounds are a proven, high-impact intervention, but their long-term success hinges on continuous education and stable team composition.Conflict of Interest No conflict of interest