Antimicrobial stewardship: Empowering labs to drive clinical impact through diagnostics

In the global fight against antimicrobial resistance (AMR), some healthcare systems are not just keeping pace — they are forging the path forward. By championing laboratory innovation, multidisciplinary collaboration, and leveraging data and analytics, three bioMérieux Centers of Excellence are redefining what is possible in antimicrobial stewardship (AMS). Their results-driven strategies and experiences offer a blueprint for the next wave of stewardship success.

The state of antimicrobial stewardship in U.S. hospitals

AMS can be defined as a coordinated, multidisciplinary initiative designed to optimize the use of antimicrobial agents, ensuring patients receive the most appropriate drug, at the correct dose, by the right route, and for the optimal duration.¹ In the United States, antimicrobial stewardship has become a healthcare standard, driven by regulatory and accreditation bodies. The Centers for Medicare & Medicaid Services (CMS) now requires all hospitals, including critical access hospitals, to implement formal stewardship programs as part of their Conditions of Participation, mandating leadership, education, monitoring, and integration into quality improvement.² These requirements align with stewardship frameworks from the Centers for Disease Control and Prevention (CDC),³ Infectious Diseases Society of America (IDSA),⁴ and The Joint Commission,⁵ reinforcing AMS as an essential component of safe, accountable patient care. The National Healthcare Safety Network (NHSN) Annual Hospital Survey reflected that 96% of acute care hospitals in the United States are adhering to the CDC framework for AMS.³ However, the journey is far from complete.

While hospitals may follow the same baseline recommendations for an antimicrobial stewardship program (ASP), it does not negate the real-world challenges that influence ultimate success. Some of these include siloed workflows, interdepartmental communication gaps, and a lack of resources needed to improve stewardship decision-making.⁶ Stewardship is not just about following guidelines — it is about empowering individuals and creating a culture where everyone, from the lab to the bedside and up to leadership, feels responsible for diagnostic and antimicrobial optimization. 

The power of collaboration: Real-world success stories

While the principles of AMS are well established, it is the integration of laboratory, pharmacy, and clinical expertise that distinguishes today’s most effective programs.⁴ Nowhere is this more evident than in the bioMérieux Antimicrobial Stewardship Centers of Excellence program, where collaborative stewardship is not just a goal — it is engrained in the culture. Comprised of 15 healthcare systems across the globe (including three in the United States), this network of AMS leaders is showcasing how to overcome barriers and redefine what is possible.⁷ These relationships leverage and scale combined strengths to innovate diagnostic tests to fight AMR.

Texas Children’s Hospital, Tampa General Hospital, and Henry Ford Health: Optimizing blood culture workflows

A breakthrough in collaborative stewardship is the multi-center initiative led by Texas Children’s Hospital, Tampa General Hospital, and Henry Ford Health. This project focused on optimizing blood culture workflows by leveraging data analytics and laboratory expertise to determine when blood culture reports could be finalized after the first bottle flags positive, rather than waiting for both aerobic and anaerobic bottles to result.

The findings were striking across all three sites; the majority of positive blood cultures (79–85%) grew a single organism, and the incidence of a second organism appearing more than 24 hours after the first was extremely low (0.9–1.4%).⁸ This evidence supports the practice of finalizing reports after the first positive bottle, reducing turnaround time and enabling faster, more targeted antimicrobial therapy or the complete discontinuation of therapy in the case of blood culture contamination.

This is a clear example of how lab-driven data streamlines clinical workflows and empowers stewardship teams to act more decisively. It’s about giving clinicians the right information at the right time to make the best decisions.  

Henry Ford Health: The nudge that makes a difference

An inspiring example of collaborative stewardship comes from Henry Ford Health in Detroit, Michigan. Their team has pioneered the use of “microbiology nudges,” which are strategic comments appended to microbiology results in the electronic health record (EHR) that guide prescribers toward optimal antibiotic use while preserving clinical autonomy. These nudges are more than passive suggestions; they are the result of close collaboration between microbiology, pharmacy, and infectious disease teams.

For example, the ASP recognized approximately 50% of Stenotrophomonas maltophilia in clinical respiratory cultures may represent colonization. The team implemented a nudge describing S. maltophilia as a frequent colonizer of the respiratory tract, suggesting clinical correlation should be considered to avoid unnecessary treatment. This intervention led to a statistically significant reduction in unnecessary antibiotic treatment, from 77% to 22% of cases, without compromising patient safety.⁹

Similarly, a nudge for non-meningitis Streptococcus pneumoniae blood stream infections was implemented with the intent to change prescribing practices to use narrower spectrum therapy. The nudge comment indicated the drugs of choice for S. pneumoniae bacteremia are IV ampicillin or penicillin, also noting the preferential therapy for meningitis (IV ceftriaxone plus vancomycin) should be used until susceptibilities are known. Optimal de-escalation in less than 48 hours occurred in 30% of cases in the pre-intervention and 67% in the post-intervention group, a statistically significant difference, with no observed differences in 30-day all cause readmission or mortality.¹⁰

What’s remarkable about Henry Ford’s approach is how it has embedded the lab’s voice into the clinical decision-making process. The microbiology team is not just reporting results; they are actively shaping prescribing behavior.

Tampa General Hospital: Accelerating susceptibility testing

Timely initiation of optimal antimicrobial therapy is essential for patients with bloodstream infections, yet traditional phenotypic methods can delay susceptibility results by several days, particularly for multi-drug-resistant organisms. As new, innovative technologies are developed to shorten time to susceptibility results, the actionability of the tests’ results are often used to assess their potential impact on patient care. Tests do not directly lead to an intervention; therefore, decision-making and actions by a clinician are considered primary determinants of the effect these technologies have on antibiotic use and patient outcomes.¹¹ At Tampa General Hospital, the laboratory team took stewardship to the next level by evaluating the time to result of fast antimicrobial susceptibility testing (AST) systems directly from positive blood cultures. In a head-to-head comparison of VITEK REVEAL (bioMérieux, US) and Accelerate Pheno (Accelerate Diagnostics, US), a total of 127 gram-negative positive blood cultures were analyzed, including P. aeruginosa (10.2%) and a range of Enterobacterales (89.8%). Overall, the two systems demonstrated high categorical agreement (93.7%) and decreased time to results (under eight hours for both systems).¹² To be actionable, fast AST results must provide accurate and sufficient information for clinicians to assess appropriateness of antibiotic therapy and determine what is the most optimal antibiotic regimen for the patient and causative pathogen.¹¹ This could allow clinicians to de-escalate or optimize therapy much earlier, reducing unnecessary broad-spectrum antibiotic use.

The ability to provide actionable susceptibility data within hours, not days, is a game-changer for stewardship. It’s about closing the loop between the lab and the bedside as quickly as possible.

Texas Children’s Hospital: Optimization of the urine culture process

Urinary tract infections are among the most common infections across the globe.¹³ Delays in urine culture turnaround times (TAT) can hinder effective patient management and compromise antimicrobial stewardship efforts. For instance, in today’s era or rising antimicrobial resistance a patient may be on an ineffective or inactive antibiotic for their UTI. Fast, actionable information for antibiotic changes is an important initiative to consider in our fight against AMR.¹³ Conventional laboratory workflows—often limited to culture reading during a single daily shift—contribute to prolonged reporting times for both positive and negative results. Texas Children’s Hospital has achieved measurable, long-term improvements in clinical laboratory performance through a urine culture laboratory optimization initiative. The kaizen project, grounded in time-based process analysis and strategic implementation of advanced technologies, such as MALDI-TOF, has significantly enhanced TATs for urine cultures.

By introducing time-based microbiology practices and streamlining workflows, the laboratory reduced TATs for positive urine cultures by 15 hours and achieved a median reduction of more than 20 hours for negative cultures.¹⁴ These improvements have been sustained over a seven-year period, underscoring the initiative’s effectiveness and durability. Efficiency in the lab has a critical role in timely patient care, and Texas Children’s emulates this translation of value to patient care.

The future of stewardship: What’s next?

The successes of these AMS Centers of Excellence demonstrate that when laboratories are empowered as equal partners in stewardship, the results can be transformative. Fast diagnostics, innovative workflows, and collaborative result reporting are not just theoretical best practices; they are proven strategies for improving patient care and combating resistance.

As we look to the future of AMS, the path forward is clear: collaboration, innovation, and laboratory leadership must take center stage. The challenges of rising AMR, evolving pathogens, and increasingly complex healthcare systems demand a united, forward-thinking response. The bioMérieux AMS Centers of Excellence continue to serve as powerful examples of what can be achieved when health systems align clinical excellence with diagnostic innovation. But sustaining and expanding this progress will require a broader collective effort. It’s up to all of us—clinicians, laboratorians, pharmacists, infection preventionists, public health, industry, government officials, health system leaders, and patients—to build on their example, advancing stewardship and safeguarding the efficacy of antibiotics for future generations.

When partners across disciplines work together with shared purpose, we strengthen the culture of accountability and open communication that is foundational to successful stewardship. No single group can combat AMR in isolation. It is only through intentional collaboration that we can identify opportunities for improvement, close practice gaps, and support behavior change at scale.

Looking ahead, several key priorities will shape the next era of stewardship:

Expanding diagnostic stewardship

Diagnostics and microbiological data are essential to ensuring timely, appropriate therapy. Integrating laboratory insights into clinical decision support tools can help frontline providers make informed treatment decisions at the point of care. This includes leveraging technologies such as MALDI-TOF, syndromic panels, and fast antimicrobial susceptibility testing, as well as building protocols that link results to guideline-driven interventions.

Enhancing interdepartmental collaboration

Effective AMS requires breaking down traditional silos between departments. By aligning on shared goals, holding regular interdisciplinary meetings, and launching joint education initiatives, teams can create an environment of mutual respect and collective ownership over stewardship practices. Such collaboration not only improves patient outcomes but also fosters a culture of continuous improvement.

Leveraging data analytics

Harnessing the power of real-time data allows stewardship teams to move from reactive to proactive intervention. Advanced analytics can help monitor prescribing patterns, detect outliers, and prioritize areas for action. By integrating antibiogram trends, diagnostic utilization data, and clinical outcomes, institutions can refine stewardship strategies and measure their impact with greater precision.

Building laboratory leadership

Laboratory professionals are uniquely positioned to drive AMS forward. Their expertise in diagnostic testing, result interpretation, and workflow efficiency is invaluable to stewardship programs. By encouraging lab leaders to actively participate in stewardship committees, clinical rounds, and quality improvement projects, we can ensure that diagnostics are not just tools, but strategic assets in the fight against AMR.

As we push forward, the need for bold thinking and sustained partnership is more urgent than ever. The opportunity to transform stewardship into a fully integrated, data-informed, and patient-centered practice is within reach.

A call to action for laboratory leaders

As demonstrated by the bioMérieux AMS Centers of Excellence, the most successful programs are those that harness the power of diagnostics, data, and teamwork to optimize antibiotic use and improve patient outcomes.

Laboratory leaders: now is your time. Antimicrobial stewardship needs your expertise to advance from good to great. By embracing your role as stewards, you can help lead the charge against AMR — one nudge, one blood culture, and one AST result at a time.

References 

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8. Initial Blood Culture Bottle Positivity: Insights from a Three‑Center Retrospective Review. Poster presented at: ASM Microbe 2025; June 22, 2025; Los Angeles, CA; Rapid‑Fire Poster.
9. Boettcher SR, Kenney RM, Arena CJ, et al. Say it ain't Steno: A microbiology nudge comment leads to less treatment of Stenotrophomonas maltophilia respiratory colonization. Infect Control Hosp Epidemiol. 2024:1-5. doi:10.1017/ice.2024.195. 
10. Akon M, et al. Internal Communication, Henry Ford Health Antimicrobial Stewardship Program.; 2025.
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12. Simmons Williams C, Becker D, Lima A, et al. Evaluation of the VITEK REVEAL AST system vs Accelerate Pheno for antimicrobial susceptibility testing of Gram-negative bacteria directly from positive blood cultures. Global. Published online 2025. Presented at: ESCMID Global 2025; April 14, 2025; Vienna, Austria. Poster P1447. Abstract 986.
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