Antimicrobial stewardship has evolved significantly over the past decade. What began as a discipline focused primarily on reducing unnecessary antibiotic use has expanded into a broader effort to optimize clinical decision-making across the entire patient journey. In the latest episode of the AMR Pathways webinar series, "Diagnostics, Data & Stewardship: Measuring What Matters," Dr. Maggie Minogue speaks with Dr. Brittany Rodriguez, Clinical Pharmacy Specialist for Antimicrobial Stewardship and Infectious Diseases at Texas Children's Hospital, about how inpatient stewardship programs are adapting to meet today's challenges and advance patient care. 

You can watch the full episode by clicking below. 

The conversation explored the growing intersection between antimicrobial stewardship, diagnostic stewardship, rapid diagnostics, data analytics, and multidisciplinary collaboration. While new technologies are creating unprecedented opportunities to optimize therapy, their success depends on how effectively healthcare teams integrate them into everyday clinical practice.

Here are three key takeaways from the discussion.

One of the most significant shifts in inpatient stewardship over the last decade has been the recognition that antimicrobial stewardship and diagnostic stewardship are inseparable. Historically, diagnostic testing and stewardship activities often occurred independently. Microbiology laboratories generated results, clinicians interpreted those findings, and stewardship teams frequently became involved only after treatment decisions had already been made. Today, stewardship leaders increasingly recognize that diagnostic decisions directly influence antibiotic use. Inappropriate testing, over testing, or results interpreted without sufficient clinical context can lead to unnecessary treatment, prolonged antibiotic exposure, and the misclassification of colonization as infection.

As a result, many healthcare organizations are shifting their focus upstream. Strategies such as clinical decision support tools, urine culture reflex protocols, and criteria-based C. difficile testing help ensure that the right test is ordered for the right patient at the right time. These approaches reduce diagnostic noise, improve clinical confidence, and support more appropriate antimicrobial use before an antibiotic is ever prescribed.

Rapid diagnostic technologies continue to transform inpatient care by shortening the time between specimen collection and actionable results. Molecular testing, rapid blood culture identification platforms, and rapid susceptibility testing can provide critical information hours or even days sooner than traditional methods.

However, as Dr. Rodriguez emphasized, technology alone does not improve outcomes.

The greatest impact occurs when rapid diagnostics are embedded within a structured stewardship workflow. Successful programs establish clear processes that connect laboratory results, stewardship review, and clinical action. When microbiology teams, pharmacists, infectious disease specialists, and frontline clinicians work together in real time, organizations can accelerate therapy optimization and support more informed treatment decisions.

Texas Children's Hospital provided several examples of how these partnerships can improve care. Their work with rapid blood culture identification demonstrated significantly faster organism identification and earlier antimicrobial optimization when stewardship pharmacists were actively involved in reviewing and communicating results. The experience reinforced an important lesson: the value of rapid diagnostics is realized not simply by generating information faster, but by ensuring the right teams can act on that information promptly.

Traditional stewardship metrics, including antibiograms and antibiotic utilization measures, remain essential for surveillance, benchmarking, and regulatory reporting. Yet many stewardship leaders are beginning to ask whether those measures alone provide the insights clinicians need at the bedside.

As diagnostics become faster and healthcare organizations gain access to more sophisticated analytics, stewardship programs are moving toward a more individualized approach. Future models may incorporate syndrome-specific antibiograms, patient-specific microbiology histories, risk prediction tools, machine learning, and real-time clinical decision support.

Rather than focusing solely on broad population-level trends, organizations will increasingly be able to answer questions specific to the patient in front of them: What is this patient's risk of a resistant infection? What is the most appropriate therapy right now? How quickly can treatment be optimized?

This shift represents a broader evolution within stewardship. Success is no longer measured solely by reducing antibiotic use. It is increasingly defined by helping clinicians make better decisions, faster, with the goal of improving patient outcomes while preserving antimicrobial effectiveness for the future.

The evolution of inpatient antimicrobial stewardship reflects a larger transformation in healthcare. Diagnostics, stewardship, data analytics, and multidisciplinary collaboration are more tightly connected than ever, creating opportunities for earlier intervention and more precise patient care.

As Dr. Rodriguez noted, the greatest opportunity over the next five years may be shifting from a reactive approach to a proactive, individualized model that helps clinicians get the right diagnosis and the right therapy to the right patient sooner. Achieving that vision will require continued collaboration across disciplines, thoughtful implementation of new technologies, and a commitment to turning data into meaningful clinical action.