Antimicrobial Stewardship

The Arkansas Children’s Antimicrobial Stewardship Program (ASP) is dedicated to ensuring that every child receives the right antibiotic, at the right time, for the right duration. Our program works to improve patient outcomes, reduce unnecessary antibiotic exposure, and preserve the effectiveness of antimicrobial therapies for future generations of children. Our multidisciplinary team – including the program director (Holly Maples), two physician medical directors (Adriana Sarmiento-Clemente, Ashleah Courtney), two full-time ASP pharmacists, microbiology partners, data analysts, and frontline clinicians – collaborates across inpatient and outpatient settings to guide antimicrobial decision-making, support clinicians in real time, and implement evidence-based practices. Through prospective audit and feedback, clinical partnerships, and data-driven interventions, we work to optimize care while minimizing harm.

A cornerstone of our approach is physician–pharmacist “handshake rounds,” which provide real-time, collaborative feedback on antimicrobial use. This model has been associated with meaningful reductions in broad-spectrum antibiotic use and more consistent, high-quality prescribing practices. Sustained engagement through these efforts has been critical to driving lasting change in clinician behavior and improving patient care.

In addition to optimizing antibiotic prescribing, our program is increasingly focused on improving the use of infectious diseases diagnostic tests; recent initiatives have reduced low-value bronchoalveolar lavage culture testing by more than 70%, streamlined bronchoscopy workflows to reduce redundant testing and improve diagnostic efficiency, and evaluated high-cost send-out molecular diagnostics, identifying limited clinical impact despite substantial cost—efforts that together reduce unnecessary antibiotic exposure and improve the overall efficiency of care.

The Arkansas Children’s ASP is actively engaged in national collaboratives that support data-driven improvement and innovation, including ASPIRE, OPerAtiC, Bright STAR, and DISCO-TEC. Through these partnerships, we leverage shared data platforms, peer benchmarking, and structured quality improvement frameworks to identify gaps in antimicrobial use, implement targeted interventions, and measure impact over time. Each initiative targets a critical area of stewardship – from improving equity in outpatient prescribing (ASPIRE), to optimizing perioperative antibiotic use (OPerAtiC), reducing unnecessary blood culture utilization in intensive care settings (Bright STAR), and strengthening antimicrobial management at hospital discharge (DISCO-TEC). Together, these efforts allow us to align local practice with national standards, accelerate the adoption of evidence-based care, and sustain meaningful improvements in antimicrobial use and patient outcomes.