Arkansas Antimicrobial Stewardship Foundation

Graphic of a bird and tapeworm. Register before Feb 20 and be eligible for a special door prize worth $100 to be drawn at the conference (must be present to win)

Register before Feb 20 and be eligible for a special door prize worth $100 to be drawn at the conference (must be present to win)

Valentine conversation hearts

Hope you're having happy Valentine's day because in ID:
We don’t fall fast, we wait for sensitivities to commit
We don't ghost you, we always follow up on cultures
We de-escalate all our drama and our broad-spectrums
We narrow our options as soon as we can - looking for Mr/Ms RIght antibiotic

Happy Valentine's Day - I'd share my plasmids with you

Nothing says love like a date at the Arkansas Summit for Antimicrobial Stewardship. We'll see you on March 13! www.arstewardship.org/2026schedule

Lincoln Neal, PharmD, is an Infectious Disease Pharmacist at Unity Health – White County Medical Center. Originally from the Central Coast of California, Dr. Neal completed his undergraduate studies at California Polytechnic State University before earning his Doctor of Pharmacy from the Harding University College of Pharmacy in Searcy, Arkansas. He further specialized his clinical training by completing a PGY1 Pharmacy Residency at Unity Health. His primary clinical interests include infectious diseases and internal medicine. Outside of his professional practice, Dr. Neal is an avid pickleball player and enjoys spending time with his wife and three children.

Today's featured speaker is Dr. Lincoln Neal. Most of us learned that "men are always complicated" (when it comes to urinary tract infections). The IDSA shook that up last year with their new UTI guidelines. Men can be uncomplicated too. www.arstewardship.org/2026schedule

I love that title. It might be my favorite on this year's program - it's a close choice between it and Dr. Brett Bailey's informatics title: "Ctrl+Alt+De-Escalate." Both are pretty clever.

Dr. Monica Mahoney is an infectious diseases pharmacist practicing in the outpatient ID and OPAT clinics at Beth Israel Deaconess Medical Center, in Boston MA. She is actively involved in several pharmacy and infectious diseases national organizations, including IDSA, SHEA, and SIDP (society of infectious diseases pharmacists) and holds fellowship status in several of them. She is an associate editor at OFID, a section editor at Contagion Live, and on the editorial advisory board at ASHE. In her spare time, she conjures up witty presentation titles and organizes monthly national virtual OPAT chats.

Meet Dr. Monica Mahoney (@mmpharmd.bsky.social), an infectious diseases pharmacist practicing in the outpatient ID and OPAT clinics at Beth Israel Deaconess Medical Center. She'll be sharing some of her experience at ARSAS. The full schedule is available now: www.arstewardship.org/2026schedule

Carnobacterium pleistocenium, a Gram-positive rod, was discovered in 32,000-year-old Alaskan permafrost and was revived after long-term freezing. SCARY.

Despite us being cold in Arkansas today, there's a real risk from the thawing Arctic permafrost. Permafrost is an archive of ancient bacteria and resistance genes that have been locked away. Thawing can release them, and they can share their genes through horizontal gene transfer. Pretty scary.

Erin McCreary, PharmD, BCIDP is a Clinical Assistant Professor within the University of Pittsburgh Department of Medicine, Division of Infectious Diseases and the Senior Director of Infectious Diseases Strategy at UPMC. She received her PharmD from the Auburn University Harrison School of Pharmacy and completed her PGY1 Pharmacy and PGY2 Infectious Diseases residencies at the University of Wisconsin Health. Dr. McCreary has led implementation of multiple infectious diseases and antimicrobial stewardship initiatives across a 37-hospital system and published numerous peer-reviewed manuscripts in these areas. She is currently the President of the Society of Infectious Diseases Pharmacists and a host of Breakpoints—The SIDP Podcast.

I'm going to start featuring some of our speakers. The first one is our keynote Dr. Erin McCreary Have you ever listened to the SIDP Breakpoints podcast? Register for ARSAS (March 13, 2026) to hear @erinmccreary.bsky.social speak about microbiology lab collaborations. tinyurl.com/ARSAS2026

Registration information for the conference.

It’s finally here! We’re super excited to open up registration for the Arkansas Summit for Antimicrobial Stewardship. We have a new venue with more space and great facilities! We also have some great topics planned. More information to come in the coming weeks.

Here are my top 10 articles (or interesting topics) for 2025 in ID. There were also new COVID guidelines and some research in treatment that didn’t make the list, and we got a few new UTI drugs (Bluejepa and Orlynvah) and Emblaveo. Fosfomycin IV finally made its way to the USA.

Environmental Factors in Tiny Tim's Near-Fatal Illness Physicians, Dickens scholars, and historians have tried to diagnose the condition that affected Tiny Tim in A Christmas Carol. Leading entities include tuberculosis (TB), rickets, malnutrition, cerebr...

I'm watching one of my favorite holiday movies: The Muppet Christmas Carol. It reminded me that Tiny Tim probably had tuberculosis (TB) & rickets. Everything is TB. Several articles have examined the conditions & common ailments in 1800s London. Here's a good one. jamanetwork.com/journals/jam...

Summary fot Blujepa, Orlyvanah and Contepo

Blujepa was approved in March of this year. Contepo was approved in November. Orlynvah was approved in October of 2024, but I threw it in here too. I actually have heard of Blujepa being used in practice, but I haven't heard of anyone seeing Orlynvah yet.

Wash your hands, get your vaccines, check travel advisories, and watch what you eat and drink when you travel this holiday season.

Stay safe on your travels next week. It's a bit too late to get vaccines for next week's travels, but it's a good idea to make sure you're up to date. Keeping your hands clean is a very important way to reduce infection risks, especially while traveling. Happy #USAAW and Happy Thanksgiving!

We can help too by making sure we stay up to date on vaccines and appointments, cleaning up after our pets, and making sure we wash our hands after handling animal waste.

Even our vets and pets can contribute to antimicrobial resistance. We mentioned livestock yesterday, but today is about how pet owners and veterinarians can help prevent antimicrobial resistance.

Graphic about farm stewardship

We often overlook agriculture and farming when thinking about antimicrobial stewardship, but we're exposed to numerous resistant bacteria from these sources. Most of the recent food recalls are due to agricultural runoff and poor manure management.

Clinical micro has an important role in stewardship: rapid diagnostics, blood culture stewardship, specimen and reporting quality, cascade reports.

Yesterday's post was about the people in direct contact with the patient. Today's #USAAW week post is about the backbone of most of our stewardship programs: the clinical micro lab. We're all in this together. We all have a role.

The Five Ds of stewardship infographic: right diagnosis, right dose, right drug, proper de-escalation, right duration

For our first #USAAW week post, let's look at the 5 Ds of Stewardship. This is one place were providers, pharmacist, and other patient care team members can make a big difference. #WereInItTogether

The PEN-FAST tool.

Mastery Monday: This came up this weekend, so I made an infographic about it. It's a pretty common question that pharmacy gets from providers at all levels. Is your patient allergic or not? Most PCN allergies aren't real, but we want to be cautious with any allergy a patient reports.

Save the date for 3-13-26 ARSAS

I don't know about you, but my nightmares are filled with superbugs and NDMs, not Freddy Krueger and Jason Voorhees. That makes March, Friday the 13th the perfect time to come together to fight and prevent these real monsters. Save the date: more details to come.

Another Mastery Monday: Sometimes, the sodium content of antibiotics matters. Just last week, there was a CHF patient with pneumonia who wasn’t improving as expected. It turns out that the culprit wasn’t infection severity; it was likely the sodium load from Zosyn (piperacillin–tazobactam). Patients with CHF are often restricted to < 2 g sodium/day. Sometimes, Zosyn alone pushes them past that (especially if mixed in normal saline, which varies by institution). Add in maintenance fluids and other IV medications, and sodium can add up quickly. It's just another thing you need to keep an eye on, especially if patients are not improving as expected and are critically ill or have kidney or heart disease. I built this chart directly from package inserts (some sources assume a standard diluent, I did not). Since diluents vary by institution, you can use it to calculate your own total sodium load.

Sometimes, the sodium content of antibiotics matters. Just last week, there was a CHF patient with pneumonia who wasn’t improving - It turns out that the culprit wasn’t infection severity; it was likely the sodium load from Zosyn (piperacillin–tazobactam). Check out our "fry scale."

Signs and symptoms of drug fever include an early onset, unremitting fever, multiple negative blood cultures, the patient seems well for the degree of fever and being on an offending drug.

It's Wednesday and I forgot to post our Mastery Monday post on here. Oops! Drug fever is relatively uncommon, with estimates varying but often placing it around 3-5% of drug-related adverse effects or 1-3% of fevers of unknown origin. If you see a persistent fever, it could be worth considering.

Enterococci are gram-positive, facultative anaerobic cocci in short and medium chains commonly found in the intestines of humans and animals. The two clinically relevant species are Enterococcus faecalis and E. faecium. Aminopenicillins, like ampicillin and amoxicillin, are usually the drugs of choice. Most resistant isolates are susceptible to vancomycin. Enterococci can acquire resistance to vancomycin through genes (e.g., vanA, vanB operons) that alter cell wall binding through the horizontal transfer of mobile genetic elements, like plasmids and transposons. This is common in E. faecium (approx. 80%) and E. faecalis (approx. 5%). Aminopenicillins remain an option for ampicillin-sensitive VRE strains. Alternative treatments are required for both penicillin and vancomycin resistant strains.

Mastery Monday: I wouldn't say Tygacil is a first line
for VRE, but it's an option (and it can be a good one for
polymicrobial intrabdominal infections associated with
VRE). Linezolid is an option even if someone is on an
SSRI, depending on the patient.

Azithromycin (brand names include Zithromax, Z-Pak and Tri-Pak) is a broad-spectrum macrolide antibiotic used to treat a wide variety of mild to moderate bacterial infections including those caused by Gram-positive, some Gram-negative, and atypical bacteria.. Azithromycin works by interfering with the bacteria's ability to produce essential proteins. Specifically, it binds to the 50S subunit of the bacterial ribosome, which prevents the process of protein synthesis and ultimately stops the bacteria from growing or multiplying.

Mastery Monday: Azithromycin is a fun antibiotic to learn about because it's kind of weird. It's also not as effective as it used to be, which is a global concern due to overprescribing because it is cheap and easily accessible. Who hasn't had an unnecessary Z-Pak? I think most of us have.

Mastery Monday: Since it's early in the school year for our new students, residents, and fellows, I thought I'd start doing some "Mastery Monday" posts with some simple, easy to digest facts that will help you all grow into good stewards. This week it's oral cephalosporins. The main point is that even though your isolate is susceptible to a ceftriaxone, that doesn't mean the drugs will cover it. We usually use cefazolin as a surrogate marker here. Also, cefdinir is kind of twerpy. It's bioavailability isn't great, it's half life isn't long. . . It still works for some infections (PharmSoHard did a really good podcast about the data and controversies in 2023, I'll link it - it goes a bit more in depth than my BioticMon cards).

Mastery Monday: This week it's oral cephalosporins.The main point is that even though your isolate is susceptible to a ceftriaxone, that doesn't mean the drugs will cover it. We usually use cefazolin as a surrogate.PharmSoHard did a really good podcast about cefdinir data and controversies in 2023.

A scale with ciprofloxacin, levofloxacin, and moxifloxacin on it with some facts about quinolones.

Mastery Monday: Since it's early in the school year for our new students, residents, and fellows, I thought I'd start doing some "Mastery Monday" posts with some simple, easy to digest facts that will help you all grow into good stewards. If you have an idea for a future topic, let me know.

We have Amanda's CAP guideline summary here, though there is a little controversy with this one!

Visual summary of the new IDSA cUTI guidelines

I've summarized the new cUTI IDSA guidelines (they came out on July 17. A new CAP guideline came out then too but there's some IDSA/ATS drama so I was waiting on the official IDSA letter for that one - who knew ID was so spicy?).

We’re gonna need a bigger boat to tackle antimicrobial resistance in our oceans! Did you know sharks have been found carrying resistant bacteria like Pseudomonas, Vibrio, Aeromonas, Enterobacterales, and Psychrobacter in their jaws? Sharks sampled off the Florida Keys showed the highest resistance to various drugs. But the real horror isn’t a shark bite (though, let’s avoid that). It’s that these sharks were exposed to resistant bacteria or antibiotic pressure and developed resistance in the first place. It’s likely from antibiotics in sewage, pharmaceutical waste, or agricultural runoff. This issue impacts us all. Let’s protect our waters and our antibiotics!

Sunday kicks off Shark Week, and it’s also the 50th Anniversary of Jaws this summer! You might wonder what sharks have to do with stewardship. As apex predators, they face many of the same challenges we do. Stewardship is a team sport and affects the whole ecosystem! #SharkWeek #jaws50

Did you know that today's holiday used to be associated with tetanus? The severity of the disease led some to compare the holiday's death toll to that of major battles for independence.

Join Our Education Committee We want to expand our outreach from the Summit to other parts of the state to further stewardship efforts. If you'd be interested in joining our education committee to discuss what opportunities you'...

Check out our latest blog post to join our education committee and find out more about the ADH survey.
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