scholarly journals 32. Impact of a Four-Year Antimicrobial Stewardship Program on Antimicrobial Resistance

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S138-S139
Author(s):  
Konstantina Chrysou ◽  
Olympia Zarkotou ◽  
Vasiliki Mamali ◽  
Nektaria Rekleiti ◽  
Katina Themeli-Digalaki ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Consumption ◽  
Audit And Feedback ◽  
Post Intervention ◽  
Stewardship Program ◽  
Primary Driver ◽  
Prospective Audit And Feedback ◽  
Resistance Rates ◽  
Hospital Acquired ◽  
The Impact

Abstract Background Antimicrobial resistance (AMR) is an increasing threat to public health and antimicrobial consumption is a primary driver of resistance. Many studies have shown that the implementation of an antibiotic stewardship program (ASP) improves prescribing of antibiotics and can reduce AMR. Purpose of the study was to assess the impact of a successful ASP, implemented for four years, on AMR in our 427-bed tertiary general hospital. Methods We monitored pharmacy data for the years 2015 (pre-intervention) and 2016-2019 (post-intervention) for antibiotic consumption (DDD/100 bed-days) and resistance rates. AMR data were obtained from the clinical microbiology laboratory’s electronic database. To achieve the goals of ASP we used a range of interventions as pre-authorization strategy for the protected antibiotics (tigecycline, carbapenems, quinolones, glycopeptides, daptomycin, colistin, linezolid), prospective audit and feedback with direct intervention, de-escalation or switch from iv to oral administration and appropriate selection and duration of chemoprophylaxis in surgery. Results Significant reductions were observed for: total antibiotics, colistin, carbapenems, quinolones and tigecycline consumption during study period. Significantly lower resistance rates were documented in 2019 compared to 2015 for Pseudomonas aeruginosa and for Klebsiella pneumoniae. As for Acinetobacter baumannii isolates, which in our hospital are highly-resistant exhibiting >90% resistance to carbapenems, no significant changes were noted during the study period. Infections caused by Gram-positive pathogens are less prevalent in our hospital. Lower rates of vancomycin-resistant enterococci were noted after the implementation of our ASP (30.4% in 2019 vs. 50.0% in 2015 for E. faecium and 0.6% vs. 6% for E. faecalis, respectively), whereas methicillin-resistant S. aureus isolates increased (40% in 2019 vs. 31.1% in 2015), possibly because most of these infections were not hospital-acquired. Resistance rates of Pseudomonas and Klebsiella Conclusion Our ASP was successful in reducing antibiotic consumption and AMR for important pathogens. Disclosures All Authors: No reported disclosures

scholarly journals Long-Term Carbapenems Antimicrobial Stewardship Program

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 15
Author(s):  
José Francisco García-Rodríguez ◽  
Belén Bardán-García ◽  
Pedro Miguel Juiz-González ◽  
Laura Vilariño-Maneiro ◽  
Hortensia Álvarez-Díaz ◽  
...  
Keyword(s):  
Ecological Impact ◽  
Bloodstream Infections ◽  
Antibiotic Consumption ◽  
Multidrug Resistant ◽  
Audit And Feedback ◽  
Post Intervention ◽  
Stewardship Program ◽  
Prospective Audit And Feedback ◽  
Hospital Acquired

Objective. To evaluate clinical and antibiotic resistance impact of carbapenems stewardship programs. Methods: descriptive study, pre-post-intervention, between January 2012 and December 2019; 350-bed teaching hospital. Prospective audit and feedback to prescribers was carried out between January 2015 and December 2019. We evaluate adequacy of carbapenems prescription to local guidelines and compare results between cases with accepted or rejected intervention. Analysis of antibiotic-consumption and hospital-acquired multidrug-resistant (MDR) bloodstream infections (BSIs) was performed. Results: 1432 patients were followed. Adequacy of carbapenems prescription improved from 49.7% in 2015 to 80.9% in 2019 (p < 0.001). Interventions on prescription were performed in 448 (31.3%) patients without carbapenem-justified treatment, in 371 intervention was accepted, in 77 it was not. Intervention acceptance was associated with shorter duration of all antibiotic treatment and inpatient days (p < 0.05), without differences in outcome. During the period 2015–2019, compared with 2012–2014, decreased meropenem consumption (Rate Ratio 0.58; 95%CI: 0.55–0.63), candidemia and hospital-acquired MDR BSIs rate (RR 0.62; 95%CI: 0.41–0.92, p = 0.02), and increased cefepime (RR 2; 95%CI: 1.77–2.26) and piperacillin-tazobactam consumption (RR 1.17; 95%CI: 1.11–1.24), p < 0.001. Conclusions: the decrease and better use of carbapenems achieved could have clinical and ecological impact over five years, reduce inpatient days, hospital-acquired MDR BSIs, and candidemia, despite the increase in other antibiotic-consumption.

scholarly journals 1141. Implementation of a Pediatric Handshake Antimicrobial Stewardship Program to Improve Antimicrobial Utilization

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S406-S406
Author(s):  
Amanda P Hughes ◽  
Maya Beganovic ◽  
Ronda Oram ◽  
Sarah Wieczorkiewicz ◽  
Anthony Chiang
Keyword(s):  
Antimicrobial Stewardship ◽  
Audit And Feedback ◽  
Prescribing Practices ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Acceptance Rates ◽  
Prospective Audit And Feedback ◽  
The Impact

Abstract Background Antimicrobial stewardship (AMS) programs emerged in response to rising rates of resistance and adverse effects associated with inappropriate antimicrobial utilization. Optimal metrics and strategies (e.g., preauthorization, prospective audit and feedback) for AMS remain to be elucidated. This study evaluated the impact of a multidisciplinary, rounding-based AMS strategy (i.e., Handshake Stewardship) on antimicrobial utilization and prescribing practices at a pediatric hospital. Methods This was a single-center, retrospective quality improvement study at a community, teaching children’s hospital. All pediatric and neonatal inpatients with active antimicrobial orders between July 2018 and March 2019 were included in the study, and endpoints were compared with data from July 2017- March 2018. Antimicrobial courses were prospectively audited by a multidisciplinary AMS team, and feedback was provided to the primary teams during Handshake Stewardship rounds. The primary endpoint was a number of interventions made and the corresponding acceptance rates. The secondary endpoint was days of therapy (DOT) per 1000 patient-days. Descriptive statistics were performed on all continuous and categorical data as appropriate. Results Of 2238 antimicrobial courses reviewed, 710 (32%) required intervention, and 86% of the interventions made were accepted. The top 3 indications evaluated were respiratory (n = 522, 23%), sepsis/bacteremia (n = 351, 16%), and surgical prophylaxis (n = 266, 12%). Of the respiratory courses reviewed, there were 228 opportunities for antimicrobial optimization. The most common interventions were: bug-drug optimization (n = 208, 29%), discontinuation of anti-infective (n = 136, 19%), and dose optimization (n = 120, 17%). No significant difference was observed for overall, ceftriaxone, meropenem, and vancomycin DOT pre- and post-implementation of Handshake Stewardship. However, a statistically significant reduction in DOTs was observed for piperacillin–tazobactam (15.2 vs. 7.4, P = 0.004) and a nonsignificant reduction in meropenem (9.5 vs. 6.2). Conclusion Rounding-based, Handshake AMS was associated with overall high intervention acceptance rates and a reduction in commonly utilized broad-spectrum antimicrobials. Disclosures All authors: No reported disclosures.

Impact of a Comprehensive Antimicrobial Stewardship Program on Institutional Burden of Antimicrobial Resistance: A 14-Year Controlled Interrupted Time-series Study

2019 ◽  
Vol 71 (11) ◽  
pp. 2897-2904 ◽  
Author(s):  
Christine Peragine ◽  
Sandra A N Walker ◽  
Andrew Simor ◽  
Scott E Walker ◽  
Alexander Kiss ◽  
...  
Keyword(s):  
Time Series ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Interrupted Time Series ◽  
Multidrug Resistant ◽  
Audit And Feedback ◽  
Time Series Study ◽  
Stewardship Program ◽  
Hospital Acquired ◽  
Series Study

Abstract Background Antimicrobial resistance (AMR) constitutes an international public health threat widely believed to result from excessive antimicrobial use (AMU). Numerous authorities have recommended antimicrobial stewardship programs (ASPs) to curb the selection of AMR, but there is a lack of data confirming this benefit. Methods A controlled interrupted time-series study spanning 14 years was performed to assess impact of a comprehensive hospital-based ASP that included pharmacist-led audit and feedback on institutional AMR. Patient-level microbiologic and AMU data were obtained from October 2002 to September 2016. Poisson regression models were used to identify changes in the incidence and trend of hospital-acquired (HA) antibiotic-resistant organisms (AROs) and multidrug-resistant organisms (MDROs). Changes in community-acquired (CA)–ARO, CA-MDRO, and inpatient AMU were assessed as controls and process outcomes. Results Statistically significant shifts in AMU, HA-ARO, and HA-MDRO trends coinciding with ASP implementation were observed, corresponding with a 9% reduction in HA-ARO burden (incidence rate ratio [IRR], 0.91 [95% confidence interval {CI}, .83–.99]; P = .03) and a 13% reduction in HA-MDRO burden (IRR, 0.87 [95% CI, .73–1.04]; P = .13) in the intervention period. In contrast, CA-ARO and CA-MDRO incidence continued to rise, with 40% (IRR, 1.40 [95% CI, 1.28–1.54]; P &lt; .0001) and 68% (IRR, 1.68 [95% CI, 1.57–1.82]; P &lt; .0001) increases in burden found, respectively. Conclusions Implementation of a comprehensive ASP resulting in reduced AMU was associated with a significant reduction in institutional AMR, even though community AMR increased during the same period. These results confirm that ASPs play an important role in the fight against AMR.

An Antimicrobial Stewardship Program Based on Systematic Infectious Disease Consultation in a Rehabilitation Facility

2016 ◽  
Vol 38 (1) ◽  
pp. 76-82 ◽  
Author(s):  
Sara Tedeschi ◽  
Filippo Trapani ◽  
Maddalena Giannella ◽  
Francesco Cristini ◽  
Fabio Tumietto ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Antibiotic Consumption ◽  
Defined Daily Dose ◽  
Antimicrobial Stewardship Program ◽  
Rehabilitation Hospital ◽  
Stewardship Program ◽  
Resistance Patterns ◽  
The Impact

OBJECTIVETo assess the impact of an antimicrobial stewardship program (ASP) on antibiotic consumption, Clostridium difficile infections (CDI), and antimicrobial resistance patterns in a rehabilitation hospital.DESIGNQuasi-experimental study of the periods before (from January 2011 to June 2012) and after (from July 2012 to December 2014) ASP implementation.SETTING150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries.INTERVENTIONBeginning in July 2012, an ASP was implemented based on systematic bedside infectious disease (ID) consultation and structural interventions (ie, revision of protocols for antibiotic prophylaxis and education focused on the appropriateness of antibiotic prescriptions). Antibiotic consumption, occurrence of CDI, and antimicrobial resistance patterns of selected microorganisms were compared between periods before and after the ASP implementation.RESULTSAntibiotic consumption decreased from 42 to 22 defined daily dose (DDD) per 100 patient days (P<.001). The main reductions involved carbapenems (from 13 to 0.4 DDD per 100 patient days; P=.01) and fluoroquinolones (from 11.8 to 0.99 DDD per 100 patient days; P=.006), with no increases in mortality or length of stay. The incidence of CDI decreased from 3.6 to 1.2 cases per 10,000 patient days (P=.001). Between 2011 and 2014, the prevalence of extensively drug-resistant (XDR) strains decreased from 55% to 12% in P. aeruginosa (P<.001) and from 96% to 73% in A. baumannii (P=.03). The prevalence of ESBL-producing strains decreased from 42% to 17% in E. coli (P=.0007) and from 62% to 15% in P. mirabilis (P=.0001). In K. pneumoniae, the prevalence of carbapenem-resistant strains decreased from 42% to 17% (P=.005), and the prevalence of in methicillin-resistant S. aureus strains decreased from 77% to 40% (P<.0008).CONCLUSIONSAn ASP based on ID consultation was effective in reducing antibiotic consumption without affecting patient outcomes and in improving antimicrobial resistance patterns in a rehabilitation hospital.Infect Control Hosp Epidemiol. 2016;1–7

scholarly journals 83. Staff Pharmacist-driven Prospective Audit and Feedback at a Community Hospital: Assessing an all Hands on Deck Approach to Antimicrobial Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S58-S59
Author(s):  
Casey J Dempsey ◽  
Natasha Weiner ◽  
Michele Riccardi ◽  
Kristin Linder
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Audit And Feedback ◽  
Small Community ◽  
Prospective Audit ◽  
Post Intervention ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
The Impact ◽  
Feedback Program

Abstract Background Facilities with robust antimicrobial stewardship programs often have infectious disease (ID) pharmacists with devoted time to complete antimicrobial stewardship initiatives. Smaller facilities with limited resources or lacking ID pharmacists, may encounter challenges meeting antimicrobial stewardship regulatory requirements. The goal of this study is to assess the impact of a staff pharmacist-driven prospective audit and feedback program in a small community hospital. Methods A pre- and post-intervention study was performed to assess the primary outcome of days of therapy per 1,000 patient days (DOT) for targeted antimicrobials (ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefepime, ceftazidime). Secondary outcomes were antibiotic expenditures and rates of Clostridioides difficile infection (CDI). Results Significant decreases in DOT were observed for piperacillin/tazobactam (29.88 vs. 9.25; p &lt; 0.001), ciprofloxacin (23.22 vs. 9.97; p &lt; 0.001), levofloxacin (11.2 vs. 5.07; p &lt; 0.001) and overall antipseudomonal DOT (62.91 vs. 51.67; p &lt; 0.001). There was no difference in ceftazidime DOT (8.75 vs. 6.47; p= 0.083) and an increase in cefepime DOT (20.47 vs. 34.35; p &lt; 0.001). A trend towards decreased rates of CDI was seen (4.9/10,000 patient days vs. 2.64/10,000 patient days; p= 0.931). There were significant decreases in antibiotic expenditures for piperacillin/tazobactam ($52,498 vs. $10,937; p &lt; 0.001), levofloxacin ($2,168 vs. $672; p &lt; 0.001), ciprofloxacin ($6,700 vs. $1,954; p &lt; 0.001). Lower expenditures for ceftazidime were seen ($9,952 vs. $7,457; p= 0.29). Cefepime expenditures increased ($25,638 vs. $40,097; p= 0.001). An overall decrease in the expenditure for the targeted antibiotics was seen ($95,715 vs. $62,837; p &lt; 0.001). Conclusion Implementation of a staff pharmacist-driven prospective authorization and feedback program led to a significant decrease in DOT and antibiotic expenditures for several targeted antibiotics and a trend towards decreased rates of CDI. Despite increased DOT and expenditures for cefepime, there was an overall decrease amongst the targeted antibiotics. With proper implementation, staff pharmacists can significantly benefit antimicrobial stewardship initiatives. Disclosures All Authors: No reported disclosures

scholarly journals 38. Impact of Antimicrobial Stewardship Interventions on Adherence to Clostridioides difficile Treatment Guidelines

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S141-S141
Author(s):  
Elizabeth Neuner ◽  
Tamara Krekel ◽  
Michael Durkin ◽  
Erik R Dubberke ◽  
Kevin Hseuh
Keyword(s):  
Antimicrobial Stewardship ◽  
Treatment Guidelines ◽  
Treatment Guideline ◽  
Small Sample ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Research Support ◽  
Post Intervention ◽  
Prospective Audit And Feedback ◽  
The Impact

Abstract Background Facility-specific treatment guidelines are a priority intervention recommended in the CDC Core Elements of Hospital Antimicrobial Stewardship Programs (ASPs). Our ASP sought to improve adherence to the facility C. difficile infection (CDI) treatment guideline by implementing prospective audit and feedback of CDI cases, changing fidaxomicin from being restricted to Infectious Diseases consult use, to only requiring prospective audit and feedback, and allowing fidaxomicin and oral vancomycin orders only through the order set. This study reviews the impact of these interventions. Methods This single-center retrospective quasi-experimental study evaluated inpatient CDI lab events 3 months pre-intervention (10/1/2019-12/31/2019) and post-intervention (10/14/2020-1/14/2021). Patient and treatment data was evaluated via chart review. The primary outcome was adherence to CDI treatment guideline. ASP intervention types were categorized. Statistical analyses were performed using Chi-squared or Fischer’s exact, where appropriate. Results Baseline characteristics were well matched between the 58 and 70 patients pre and post intervention respectively (Table 1). ASP interventions resulting from the prospective audit and feedback are described in Table 2 and overall acceptance rates were high (88%). Guideline adherence improved significantly from 71% pre to 90% post-intervention (p=0.005). Reasons for non-adherence included vancomycin dose incorrect for the severity of illness (9 pre vs 2 post), inappropriate duration (4 pre vs 0 post), use of combination therapy in non-fulminant disease (5 pre vs 3 post), and not using fidaxomicin for recurrent disease (3 pre vs 2 post). Clinical outcomes pre and post intervention were not different in this small sample size: colectomy 1 (2%) vs 1 (1%) p=1, 60 day all- cause mortality 15 (26%) vs 14 (20%) p=0.43, and CDI recurrence at day 60 9/43 (21%) vs 5/56 (9%) p=0.131. Conclusion A bundle of ASP interventions including prospective audit and feedback of CDI cases improved adherence to facility-specific CDI treatment guidelines. Disclosures Tamara Krekel, PharmD, BCPS, BCIDP, Merck (Speaker’s Bureau) Erik R. Dubberke, MD, MSPH, Ferring (Grant/Research Support)Merck (Consultant)Pfizer (Consultant, Grant/Research Support)Seres (Consultant)Summit (Consultant)

scholarly journals 37. Impact of a Vancomycin/Piperacillin-tazobactam Audit and Feedback Program

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S140-S141
Author(s):  
Vidya Atluri ◽  
Frank Tverdek ◽  
Sarah Elsayed ◽  
Beverly Chan ◽  
Catherine Liu ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Renal Injury ◽  
Medical Center ◽  
Academic Medical Center ◽  
Audit And Feedback ◽  
Post Intervention ◽  
The Difference ◽  
Prospective Audit And Feedback ◽  
The Impact ◽  
Feedback Program

Abstract Background Vancomycin and piperacillin-tazobactam (VPT) combination therapy is associated with nephrotoxicity and provides broad-spectrum coverage that may be unnecessary. We conducted a pre-post implementation study to assess the impact of an audit and feedback program for VPT at our academic medical center. Methods Automated alerts were used to identify patients on VPT at the University of Washington Medical Center (UWMC)-Montlake (ML) and UWMC-Seattle Cancer Care Alliance (SCCA) hospitals. Baseline data was collected on patients from 1/20/20-6/2/20: electronic medical records were reviewed for antibiotic indication, duration, renal function, and presence of Infectious Disease (ID) consult. From 6/25/20-10/31/20, all patients on combination therapy without an ID consult were reviewed by the antimicrobial stewardship programs at ML and SCCA, respectively. If intervention was warranted, the ML steward discussed the case with the provider then documented the conversation. The SCCA steward, instead, discussed the case with the team pharmacist. The primary outcome was change in VPT duration post intervention. Secondary outcomes included nephrotoxicity rates and carbapenem escalation. Results Prior to the intervention, 66 ML and 33 SCCA patients were started on the combination compared to 110 ML and 50 SCCA patients post-intervention. Overall, 50% of ML and 14% of SCCA patients were on surgical primary services. Amongst ML patients, there was a decrease in patients on VPT for &gt; 4 days (22 % to 8%), incidence of renal injury (30.3% to 10%), and percentage of ID consults (53.0% to 43.6%). Escalation to a carbapenem was stable (4.5% to 4.5%). In SCCA patients the percentage of patients on VPT for &gt; 4 days decreased slightly (18.2% to 15.2%), incidence of renal injury was stable (18.2% to 18%), percentage of ID consults increased (45.5% to 50.0%), and escalation to a carbapenem was stable (12.1% vs 13.5%). Conclusion Prospective audit and feedback of VPT was associated with a decrease in duration and nephrotoxicity in ML but not SCCA patients. The difference in outcomes could be due to the patient populations, primary services, or intervention process. This study highlights the importance of tailoring interventions even within the same medical system. Disclosures All Authors: No reported disclosures

scholarly journals 87. Utilization of Methicillin-Sensitive/Resistant Staphylococcus aureus Nares Screen to Decrease Vancomycin and Linezolid Use in Hospitalized Patients with Respiratory Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S60-S60
Author(s):  
Noor F Zaidan ◽  
Rachel S Britt ◽  
David Reynoso ◽  
R Scott Ferren
Keyword(s):  
Staphylococcus Aureus ◽  
Respiratory Infections ◽  
Intervention Group ◽  
Kidney Injury ◽  
Post Intervention ◽  
Gram Positive ◽  
Stewardship Program ◽  
Screening Protocol ◽  
The Impact ◽  
Post Intervention Group

Abstract Background Pharmacist-driven protocols for utilization of methicillin-resistant Staphylococcus aureus (MRSA) nares screenings have shown to decrease duration of empiric gram-positive therapy and rates of acute kidney injury (AKI) in patients with respiratory infections. This study evaluated the impact of a pharmacist-driven MRSA nares screening protocol on duration of vancomycin or linezolid therapy (DT) in respiratory infections. Methods Patients aged 18 years and older with a medication order of vancomycin or linezolid for respiratory indication(s) were included. The MRSA nares screening protocol went into effect in October 2019. The protocol allowed pharmacists to order an MRSA nares polymerase chain reaction (PCR) for included patients, while the Antimicrobial Stewardship Program (ASP) made therapeutic recommendations for de-escalation of empiric gram-positive coverage based on negative MRSA nares screenings, if clinically appropriate. Data for the pre-intervention group was collected retrospectively for the months of October 2018 to March 2019. The post-intervention group data was collected prospectively for the months of October 2019 to March 2020. Results Ninety-seven patients were evaluated within both the pre-intervention group (n = 50) and post-intervention group (n = 57). Outcomes for DT (38.2 hours vs. 30.9 hours, P = 0.601) and AKI (20% vs. 14%, P = 0.4105) were not different before and after protocol implementation. A subgroup analysis revealed a significant reduction in DT within the pre- and post-MRSA PCR groups (38.2 hours vs. 24.8 hours, P = 0.0065) when pharmacist recommendations for de-escalation were accepted. Conclusion A pharmacist-driven MRSA nares screening protocol did not affect the duration of gram-positive therapy for respiratory indications. However, there was a reduction in DT when pharmacist-driven recommendations were accepted. Disclosures All Authors: No reported disclosures

scholarly journals Implementation of a Rapid Phenotypic Susceptibility Platform for Gram-Negative Bloodstream Infections With Paired Antimicrobial Stewardship Intervention: Is the Juice Worth the Squeeze?

2021 ◽  
Author(s):  
Evan D Robinson ◽  
Allison M Stilwell ◽  
April E Attai ◽  
Lindsay E Donohue ◽  
Megan D Shah ◽  
...  
Keyword(s):  
Median Time ◽  
Antimicrobial Stewardship ◽  
A Priori ◽  
Bloodstream Infections ◽  
Standard Of Care ◽  
Post Intervention ◽  
Gram Negative ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Implementation of the Accelerate PhenoTM Gram-negative platform (RDT) paired with antimicrobial stewardship program (ASP) intervention projects to improve time to institutional-preferred antimicrobial therapy (IPT) for Gram-negative bacilli (GNB) bloodstream infections (BSIs). However, few data describe the impact of discrepant RDT results from standard of care (SOC) methods on antimicrobial prescribing. Methods A single-center, pre-/post-intervention study of consecutive, nonduplicate blood cultures for adult inpatients with GNB BSI following combined RDT + ASP intervention was performed. The primary outcome was time to IPT. An a priori definition of IPT was utilized to limit bias and to allow for an assessment of the impact of discrepant RDT results with the SOC reference standard. Results Five hundred fourteen patients (PRE 264; POST 250) were included. Median time to antimicrobial susceptibility testing (AST) results decreased 29.4 hours (P &lt; .001) post-intervention, and median time to IPT was reduced by 21.2 hours (P &lt; .001). Utilization (days of therapy [DOTs]/1000 days present) of broad-spectrum agents decreased (PRE 655.2 vs POST 585.8; P = .043) and narrow-spectrum beta-lactams increased (69.1 vs 141.7; P &lt; .001). Discrepant results occurred in 69/250 (28%) post-intervention episodes, resulting in incorrect ASP recommendations in 10/69 (14%). No differences in clinical outcomes were observed. Conclusions While implementation of a phenotypic RDT + ASP can improve time to IPT, close coordination with Clinical Microbiology and continued ASP follow up are needed to optimize therapy. Although uncommon, the potential for erroneous ASP recommendations to de-escalate to inactive therapy following RDT results warrants further investigation.

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