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Background Rapid diagnostic tests (RDTs), such as Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF), have been shown to improve time to effective therapy and positively impact patient outcomes when used along with antimicrobial stewardship team (AST) intervention in treating bloodstream infections (BSIs). The purpose of this study was to assess the impact of MALDI-TOF (implemented May 25, 2016) and AST intervention on management of BSIs at a smaller, resource-limited institution. Methods IRB-approved, single-center, pre-post quasi-experiment including all patients treated for BSI at the University of Toledo Medical Center from November 1, 2015-November 30, 2016. Patients transferred with documented BSI, expired prior to organism identification, or had blood culture positive for Mycobacterium, Nocardia, anaerobes, or molds were excluded. Primary endpoint: time to effective therapy. Secondary endpoints: time to optimal therapy, hospital length of stay (LOS), recurrent bacteremia, and 30-day readmission and all-cause mortality. Results 593 blood cultures screened, 261 included; 131 pre- and 130 post-MALDI-TOF implementation. Baseline characteristics similar between groups. Median (IQR) time to effective therapy was 6.1 h (2.3–20.0) pre-MALDI-TOF and 6.4 hours (2.2–23.7) post-MALDI-TOF, P = 0.609. Median (IQR) time to optimal therapy was 67.3 (48.6–93.2) pre-MALDI-TOF and 67.2 (44.3–94.0) post-MALDI-TOF, P = 0.520. Secondary endpoints shown in Table 1. In a subset of cultures defined as contaminants, reduction was seen in time to discontinuation of therapy, however not statistically significant (93.8 hours (61.8–131.4) vs. 71.1 hours (57.5–106.3); P = 0.180). Conclusion Implementation of MALDI-TOF and AST intervention did not significantly improve an already prompt time to effective therapy in patients with BSIs at our institution. Time to optimal therapy was also similar, highlighting the need for more rapid susceptibility tests in order to support earlier de-escalation of therapy.Table 1. Clinically Evaluable Endpoints Pre-MALDI-TOF (n = 108) Post-MALDI-TOF (n = 104) P-value Hospital LOS (days) 9.1 (6.2–15.6) 10.0 (6.3–15.7) 0.823 Recurrent bacteremia 6 (5.6) 4 (3.8) 0.748 30-day readmission 24 (22.2) 18 (17.3) 0.369 30-day, all-cause mortality 16 (14.8) 19 (18.3) 0.498 Values reported as median (IQR) or n(%). Disclosures All authors: No reported disclosures.

open forum infectious diseases

Implementation of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) and Antimicrobial Stewardship Intervention at an Academic Medical Center