empiric antibiotic therapy
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Tafese Beyene Tufa ◽  
Colin R. Mackenzie ◽  
Hans Martin Orth ◽  
Tobias Wienemann ◽  
Tamara Nordmann ◽  

Abstract Background Infectious diseases are among the leading causes of death in many low-income countries, such as Ethiopia. Without reliable local data concerning causative pathogens and antimicrobial resistance, empiric treatment is suboptimal. The objective of this study was to characterize gram-negative bacteria (GNB) as pathogens and their resistance pattern in hospitalized patients with infections in central Ethiopia. Methods Patients ≥ 1 year of age with fever admitted to the Asella Referral and Teaching Hospital from April 2016 to June 2018 were included. Blood and other appropriate clinical specimens were collected and cultured on appropriate media. Antibiotic susceptibility testing (AST) was performed using the Kirby–Bauer method and VITEK® 2. Species identification and detection of resistance genes were conducted using MALDI-ToF MS (VITEK® MS) and PCR, respectively. Results Among the 684 study participants, 54.2% were male, and the median age was 22.0 (IQR: 14–35) years. Blood cultures were positive in 5.4% (n = 37) of cases. Among other clinical samples, 60.6% (20/33), 20.8% (5/24), and 37.5% (3/8) of swabs/pus, urine and other body fluid cultures, respectively, were positive. Among 66 pathogenic isolates, 57.6% (n = 38) were GNB, 39.4% (n = 26) were gram-positive, and 3.0% (n = 2) were Candida species. Among the isolated GNB, 42.1% (16/38) were Escherichia coli, 23.7% (9/38) Klebsiella pneumoniae and 10.5% (4/38) Pseudomonas aeruginosa. In total, 27/38 gram-negative isolates were available for further analysis. Resistance rates were as follows: ampicillin/sulbactam, 92.6% (n = 25); cefotaxime, 88.9% (n = 24); ceftazidime, 74.1% (n = 20); cefepime, 74.1% (n = 20); gentamicin, 55.6% (n = 15); piperacillin/tazobactam, 48.1% (n = 13); meropenem, 7.4% (n = 2); and amikacin, 3.7% (n = 1). The blaNDM-1 gene was detected in one K. pneumoniae and one Acinetobacter baumannii isolate, which carried an additional blaOXA-51 gene. The ESBL enzymes were detected in 81.5% (n = 22) of isolates as follows: TEM, 77.2% (n = 17); CTX-M-1 group, 68.2% (n = 15); SHV group, 27.3% (n = 6); and CTX-M-9 group, 9.1% (n = 2). Based on the in vitro antimicrobial susceptibility results, empiric treatment initiated in 13 of 18 (72.2%) patients was likely ineffective. Conclusion We report a high prevalence of ESBL-producing bacteria (81.5%) and carbapenem resistance (7.4%), with more than half of GNB carrying two or more ESBL enzymes resulting in suboptimal empiric antibiotic therapy. These findings indicate a need for local and national antimicrobial resistance surveillance and the strengthening of antimicrobial stewardship programs.

2022 ◽  
Vol 12 (2) ◽  
Jessica Craig ◽  
Isabel Frost ◽  
Aditi Sriram ◽  
James Nuttall ◽  
Geetanjali Kapoor ◽  

Standard treatment guidelines (STGs) are an important tool for ensuring high quality clinical care and prudent antimicrobial use (AMU) and stewardship (AMS). In 2018, African Union (AU) member state representatives recognized the lack of STGs as a barrier to AMS at national and facility levels. Previous research reported that only 17 of 55 (31%) member states had STGs that provided disease- or pathogen-specific antimicrobial treatment recommendations, excluding those that covered only treatment of HIV, malaria, and tuberculosis). The Africa Centres for Disease Control and Prevention convened expert panels to develop first edition antibiotic treatment guidelines for priority infectious diseases and clinical syndromes for pediatric and adult patient populations in Africa. The purpose of the guidelines is to provide healthcare workers with treatment guidance by harmonising existing national STGs, filling gaps where existing STGs are not available, and serving as a model for future guidelines. Two expert panels of 28 total clinicians, pharmacists, and other relevant stakeholders from 14 AU member states representing each continental region convened to develop consensus treatment recommendations for select priority bacterial infections and clinical syndromes. In developing recommendations, the panels considered treatment recommendations from existing STGs, drug availability, clinical experience, and available antimicrobial resistance data. The guidelines underwent an external review process where clinical stakeholders who did not serve on either panel were invited to submit feedback prior to their publication. The guidelines provide empiric antibiotic therapy guidelines – including drug selection, route of administration, formulation, dosage, and therapy duration – and principles of stewardship for 28 bacterial infections or clinical syndromes. The first edition guidelines for the treatment of common infectious diseases and clinical syndromes in Africa aims to improve clinical treatment and antimicrobial stewardship and will serve as a template for future regional guidelines.

2022 ◽  
Vol 12 ◽  
Khezar Hayat ◽  
Zia Ul Mustafa ◽  
Muhammad Nabeel Ikram ◽  
Muhammad Ijaz-Ul-Haq ◽  
Irum Noor ◽  

Background: Patients with coronavirus disease 2019 (COVID-19) could experience multiple coinfections, and judicial antimicrobials, including antibiotics, is paramount to treat these coinfections. This study evaluated physicians’ perception, attitude, and confidence about antimicrobial resistance (AMR) and antimicrobial prescribing in patients with COVID-19.Methods: A self-administered and validated online questionnaire comprised of six sections was disseminated among physicians working in public sector hospitals in Punjab, Pakistan, using the convenience sampling method from April to May 2021. The study also assessed the validity and reliability of the study questionnaire using exploratory factor analysis and Cronbach’s alpha. In addition, the descriptive and inferential statistics present survey results.Results: A total of 387 physicians participated in this study. The study showed that the questionnaire demonstrated good internal consistency (Cronbach’s alpha = 0.77). Most physicians (n = 221, 57.1%) believed that AMR is a considerable problem in Pakistan. Less than a quarter of respondents (n = 91, 23.5%) consulted with local antibiotic resistance data to prescribe antibiotics in COVID-19 patients. However, the respondents were confident to select a suitable antibiotic (n = 229, 59.2%). More than three-quarters of the respondents believed that advice from a senior colleague (n = 336, 86.8%), infectious disease (ID) physician (n = 315, 81.4%), and implementing antimicrobial stewardship programs (ASPs) could facilitate appropriate prescribing of antibiotics in COVID-19 patients. Multivariate logistic regression revealed that physicians with more than 10 years of experience had higher odds of consulting local guidelines for antibiotic therapy (OR, 4.71 95% CI: 1.62–13.73, p = 0.004) than physicians with less than 5 years of experience. Similar trends were found for consulting national guidelines and local resistance data to select an empiric antibiotic therapy.Conclusion: AMR-related awareness was optimal among physicians. Only a few physicians looked up local antibiotic resistance data before prescribing antibiotics to COVID-19 patients empirically. The significant approaches advised by physicians to reduce AMR risk among COVID-19 patients were the implementation of ASPs combined with advice from ID physicians.

Vestnik ◽  
2021 ◽  
pp. 68-74
М.Е. Рамазанов ◽  
В.Н. Сон ◽  
М.Р. Рысулы ◽  
С.Т. Турсуналиев ◽  
Е.Б. Еспенбетов

Представлены результаты проспективного обследования 80 больных ГКБ №7 с бактериемией с октября 2019 года по февраль 2021 года из различных отделений госпиталя. Производилась оценки показателей маркеров сепсиса - пресепсина, прокальцитонина и С-реактивного белка (СРБ) в крови больных в динамике эмпирической терапии антимикробными препаратами (АМП). Наибольшее число больных с выявленной бактериемией находилось в отделении ОАРИТ - 39 пациентов, у 25 из них был диагностирован сепсис по шкале СЕПСИС III, вызванный известными патогенами Staphylococcus aureus (46,6%) и Escherichia coli (36,6%). Для эмпирического лечения применялись различные антибиотики: ампенициллин, амикацин, меропенем, цефотаксим, метрид, ципрофлоксацин, ципрокс, цефлокс, цефазолин, цефтриаксон, левофлоксацин. Уровни прокальцитонина составляют для больных с клиническими изолятами E. coli 20,8±3,1нг/мл, а для изолятов St. aureus 15,7±1,8 нг/мл. После терапии АМП наблюдается значительное снижение показателей до 1,43±0,6 и 2,3±0,9 нг/мл., что позволяет признать эффективность эмпирической антибиотикотерапии при инфекциях кровотока. Высокая чувствительность клинических изолятов Escherichia coli отмечена к препаратам группы карбапенемов - имипенему и меропенему (90,9%), низкая к эртапенему (72,7%). 100% чувствительность все изоляты показали по отношению к АМП из группы глицилциклинов - тигециклину, который структурно сходен с тетрациклинами. Высокой резистеностью клинические изоляты Staphylococcus aureus обладают к пенициллину (92,9%), липопептиду природного происхождения даптомицину (85,8%) и препарату из группы линкозамидов - клиндамицину (64,3%). The results of a prospective examination of 80 patients with bacteremia from October 2019 to February 2021 from various departments of the hospital are presented. The largest number of patients with detected bacteremia were in the OARIT department - 39 patients, 25 of them were diagnosed with sepsis according to the SEPSIS III scale, caused by known pathogens Staphylococcus aureus (46.6%) and Escherichia coli (36.6%). For empirical treatment, various antibiotics were used: ampenicillin, amikacin, meropenem, cefotaxime, metrid, ciprofloxacin, ciprox, ceflox, cefazolin, ceftriaxone, levofloxacin. Procalcitonin levels for patients with clinical E. coli isolates are 20.8 ± 3.1 ng / ml, and for St. aureus 15.7 ± 1.8 ng / ml. After AMP therapy, there is a significant decrease in indicators to 1.43 ± 0.6 and 2.3 ± 0.9 ng / ml, which makes it possible to recognize the effectiveness of empiric antibiotic therapy for bloodstream infections. High sensitivity of clinical isolates of Escherichia coli was noted to drugs of the carbapenem group - imipenem and meropenem (90.9%), low to ertapenem (72.7%). All isolates showed 100% sensitivity to AMPs from the glycylcycline group - tigecycline, which is structurally similar to tetracyclines. Clinical isolates of Staphylococcus aureus are highly resistant to penicillin (92.9%), natural lipopeptide daptomycin (85.8%), and a drug from the lincosamide group - clindamycin (64.3%).

2021 ◽  
Vol 8 (1) ◽  
pp. 92-98
Irene Pomilio ◽  
Isidoro Mazzoni

Introduction: Hospital-acquired infections (HAIs) are the most serious and frequent complication of healthcare systems. In 2019 the Marche Region has introduced a project to check HAIs and also the use of antibiotics in empirical therapy. The aim of this analysis was to conduct a periodic descriptive prevalence study according to the regional plan. Materials and Methods: In the quarter January-March 2020, the Internal Medicine Department of the Mazzoni Hospital of Ascoli Piceno has been considered, enrolling patients with HAIs to whom has been prescribed at least one antibiotic in empirical therapy. To assess the prevalence of multi-drug resistant organisms (MDRO), microbiological isolates were examined and laboratory response times were measured as a quality indicator. Besides, the incidence of HAIs from medical device, the clinical outcomes and the average length of stay have been analyzed. Results: The results show: high incidence of HAIs and high percentage of MDRO. The response time of the laboratory analysis is on average over 48-72 hours after sampling. The data show a widespread use of broad-spectrum antibiotics and low adherence to the new regional empiric therapy guidelines. Conclusions: The high incidence of HAIs implies the urgent need of an active surveillance of an Antimicrobial Stewardship team. This would represent a strategic solution to prevent and limit antimicrobial resistance and reduce morbidity, mortality and costs.

2021 ◽  
Vol 23 (Supplement_G) ◽  
Rita Cristina Myriam Intravaia ◽  
Massimiliano Monticelli ◽  
Francesco Musca ◽  
Benedetta De Chiara ◽  
Francesca Casadei ◽  

Abstract A 34-year-old patient arrived in Emergency Department (ED) with a history of haemoptysis, fever, and night sweats. Echocardiographic examination revealed a large isoechoic thickening that totally encompassed posterior mitral leaflet and which extended contiguously, both inferiorly with subvalvular apparatus with chordal fusion, and superiorly up to left atrial wall. This alteration caused a moderate mitral stenosis with an estimated average gradient of 10–15 mmHg (with possible overestimation due to temporary state of hyperdynamic circulation secondary to anaemization). There also was an anteriorly directed, eccentric jet of mitral regurgitation (2 +/4 + grade).Differential diagnosis of the aforementioned mitral formation included infectious etiology (endocarditic vegetation), pure phlogistic (inflammatory/rheumatic valvulitis), aseptic vegetation, and thrombosis. Transesophageal echocardiographic evaluation showed the extension of the mass into posterior leaflet, the latter completely englobed from commissure to commissure, and cranially adhered to posterior wall of left atrium with estimated dimensions of 1.9 × 12 mm; inferiorly, contiguity with diffusely thickened subvalvular apparatus and chordal fusion, was appreciated. Resulting stenosis was about 13–14 mmHg. Planimetric mitral valve area was estimated to be about 1 cm with associated mild-moderate regurgitation. Global systolic function was preserved with normal segmental kinesis and without significant anomalies affecting other valves. On cardiac magnetic resonance (CMR) with contrast medium, known sleeve thickening of left atrium (maximum thickness 12 mm in lateral area and 7.5 mm at the level of atrial septum) was extended caudocranially for 2.5 cm in lateral area and for 3.2 cm in the side of the atrial septum and with subocclusion of left inferior pulmonary vein. An esophagogastroduodenoscopy (EGDS) was performed with biopsy examination and subsequent histological typing. It concluded for ‘undifferentiated pleomorphic sarcoma’ according to the WHO classification of thoracic tumours. In the stomach there was a diffuse infiltration of lamina propria by atypical, pleomorphic, and large cellular elements. Following cancer evaluation, first-line chemotherapy with ifosfamide and doxorubicin was undertaken. Two days later, due to finding of hyperpyrexia, with a feverish peak of up to 39°, infusion of chemotherapy was interrupted and empiric antibiotic therapy (piperacillin tazobactam) was started. Blood and urine cultures were carried out with search for antigens of legionella and pneumococcus, (MRSA), fungi, and respiratory viruses but all of them were negative for active infection. The following day, an episode of acute respiratory failure occurred, so we performed an urgent chest CT with finding of pneumonia with bilateral pleural effusion and linezolid was started. Because of sudden worsening of clinical conditions, patient was transferred to ICCU (Intensive Cardiac Care Unit) with gradual resolution of desaturation. Cardiac ultrasound imaging, from the very first performed in ED, has been fundamental in documenting the presence of a mass in mitral valve. The timeliness in identifying first and then characterizing it certainly had a positive impact on cancer management, especially in such an aggressive neoplasm in a young patient. Furthermore diagnostic process, corroborated by instrumental data provided by ecocardiography, CT, MRI, PET, and scintigraphy, allowed a better staging of the disease and highlighted other organ involvement in order to manage optimal therapeutic approach.

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1410
Siegmund Lang ◽  
Astrid Frömming ◽  
Nike Walter ◽  
Viola Freigang ◽  
Carsten Neumann ◽  

Background: Empiric antibiotic therapy for suspected vertebral osteomyelitis (VO) should be initiated immediately in severely ill patients, and might be necessary for culture-negative VO. The current study aimed to identify differences between community-acquired (CA) and healthcare-associated (HA) VO in terms of clinical presentation, causative pathogens, and antibiotic susceptibility. Methods: Cases of adult patients with VO treated at a German university orthopaedic trauma center between 2000 and 2020 were retrospectively reviewed. Patient history was used to distinguish between CA and HA VO. Susceptibility of antibiotic regimens was assessed based on antibiograms of the isolated pathogens. Results: A total of 155 patients (with a male to female ratio of 1.3; and a mean age of 66.1 ± 12.4 years) with VO were identified. In 74 (47.7%) patients, infections were deemed healthcare-associated. The most frequently identified pathogens were Staphylococcus aureus (HAVO: 51.2%; CAVO: 46.8%), and Coagulase-negative Staphylococci (CoNS, HAVO: 31.7%; CAVO: 21.3%). Antibiograms of 45 patients (HAVO: n = 22; CAVO: n = 23) were evaluated. Significantly more methicillin-resistant isolates, mainly CoNS, were found in the HAVO cohort (27.3%). The highest rate of resistance was found for cefazolin (HAVO: 45.5%; CAVO: 26.1%). Significantly higher rates of resistances were seen in the HAVO cohort for mono-therapies with meropenem (36.4%), piperacillin–tazobactam (31.8%), ceftriaxone (27.3%), and co-amoxiclav (31.8%). The broadest antimicrobial coverage was achieved with either a combination of piperacillin–tazobactam + vancomycin (CAVO: 100.0%; HAVO: 90.9%) or meropenem + vancomycin (CAVO: 100.0%; HAVO: 95.5%). Conclusion: Healthcare association is common in VO. The susceptibility pattern of underlying pathogens differs from CAVO. When choosing an empiric antibiotic, combination therapy must be considered.

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S657-S658
Stephanie Hawkins ◽  
Patrick Gavigan ◽  
Jessica E Ericson ◽  
George McSherry

Abstract Background In children, urinary tract infection (UTI) represents one of the most common indications for antibiotics. While previous data has demonstrated high rates of misdiagnosis and inconsistencies with empiric antibiotics, the impact and opportunities for antibiotic reduction once final culture and susceptibility data are available, particularly in pediatric patients seen in the emergency department (ED), is unknown. Methods This was a retrospective study conducted over a period of 18-months, which included subjects less than 18 years of age who were discharged from the ED with a diagnosis of UTI. Episodes in which urine cultures were negative or grew only mixed urogenital flora were considered possible for discontinuation. De-escalation was considered possible in episodes in which identified bacteria were susceptible to more narrow spectrum agents than the prescribed empiric antibiotic. Rates of discontinuation and de-escalation were calculated as proportions, and excess days of therapy were described. Subjects whose empiric antibiotics were active against isolated bacteria were compared to those with bacteria resistant to empiric therapy. Results A total of 87 episodes of UTI were identified. Pathogenic bacteria were isolated in 51 (59%) of the 78 episodes in which urine cultures were sent, most commonly Escherichia coli (84%). Empiric antibiotic therapy and duration varied and were active against isolated bacteria in 39 (76%) of the episodes. Subjects whose antibiotics were inactive were more likely to be Hispanic and receive cephalexin [Table 3]. Antibiotics were discontinued in 3 of the 27 possible episodes (11%), resulting in 127 extra antibiotic days, median of 6 (IQR=10 days) days per episode. In 20 episodes there was an opportunity for de-escalation, but it was never attempted, leading to 131 extra days of broad-spectrum antibiotics (median 7.5 days, IQR=3). Table 1. Microbiology and resistance profile of bacteria isolated from urine cultures Table 2. Empiric antibiotic regimens, including type of antibiotic and duration Table 3. Comparison of episodes in which empiric antibiotics were active against isolated bacteria versus those in which empiric antibiotics were inactive Conclusion Antibiotics are rarely adjusted after discharge from the ED. Lack of adjustment results in unnecessary total and broad-spectrum antibiotic exposures. Initiatives designed to improve antibiotic use post-discharge could result in significant decreases in unnecessary antibiotics, and ultimately reduced rates of antibiotic resistance. Disclosures All Authors: No reported disclosures

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S65-S66
Justin J Choi ◽  
Lars Westblade ◽  
Lee S Gottesdiener ◽  
Kyle Liang ◽  
Han A Li ◽  

Abstract Background Multiplex polymerase chain reaction (PCR) panels allow for rapid detection or exclusion of pathogens causing community-acquired meningitis and encephalitis (ME). However, the clinical impact of rapid multiplex PCR ME panel results on the duration of empiric antibiotic therapy is not well characterized. Methods We performed a retrospective pre-post study to evaluate the implementation of the FilmArray ME panel (BioFire Diagnostics, LLC) for diagnosis of bacterial meningitis at our institution. We included adults who presented with suspected bacterial meningitis, received empiric antibiotic therapy, and underwent cerebrospinal fluid microbiological testing in the emergency department. The primary outcome was duration of empiric antibiotic therapy. A bivariable analysis that compared baseline demographics, clinical characteristics, and study outcomes between the pre-ME panel and post-ME panel periods was performed using Mann-Whitney tests, chi-squared tests, or Fisher’s exact tests. Time-to-event analysis used the Kaplan-Meier method and log-rank statistics. Results In the pre-ME panel period, the positive detection rate of bacterial pathogens was 2.2% (3/137) by cerebrospinal fluid culture and 4.3% (3/69) in the post-ME panel period. Table 1 shows baseline characteristics of patients. Compared to the pre-ME panel period, there were significant reductions in the post-ME panel period for the duration of empiric antibiotic therapy (median 34.7 h, IQR 8.5–61.7, vs. 12.3 h, IQR 3.3–40.0, P=0.01), time to targeted therapy (59.3 h, IQR 36.5–74.6, vs 7.02 h, IQR 0.9–12.4, P< 0.001), and hospital length of stay (4 d, IQR 2–7, vs. 3 d, IQR 1–5, P=0.03), as shown in Table 2. There was also significant reduction in time to discontinuation or de-escalation of empiric antibiotic therapy (P=0.049) as shown in Figure 1. Table 1. Baseline characteristics for patients with suspected bacterial meningitis Table 2. Antimicrobial use and hospitalization outcomes Compared to the pre-ME panel period, there were significant reductions in the post-ME panel period for the duration of empiric antibiotic therapy (P=0.01), time to targeted therapy (P<0.001), and hospital length of stay (P=0.03). Figure 1. Probability of Empiric Antibiotic Therapy Between Pre- and Post-ME Panel Periods Kaplan-Meier analysis of the time from initiation of empiric antibiotic therapy to discontinuation or de-escalation of empiric antibiotic therapy between the pre- and post-ME panel periods. P value from log-rank test=0.049 (n=206). There was a significant difference in the time to discontinuation or de-escalation of empiric antibiotic therapy between the groups (sex- and immunosuppressant use-adjusted hazard ratio, 1.46 [95% confidence interval, 1.08–1.97]; P=0.01). Conclusion The implementation of the FilmArray ME panel for suspected bacterial meningitis appears to reduce the duration of empiric antibiotic therapy, time to targeted therapy, and hospital length of stay compared to traditional culture-based microbiological testing methods. Disclosures Justin J. Choi, MD, Allergan (Consultant, Grant/Research Support)Roche (Consultant, Grant/Research Support) Lars Westblade, PhD, Accelerate Diagnostics Inc (Grant/Research Support)BioFire Diagnostics (Grant/Research Support)Hardy Diagnostics (Grant/Research Support)Roche (Consultant, Advisor or Review Panel member)Shionogi Inc (Advisor or Review Panel member)Talis Biomedical (Advisor or Review Panel member) Marshall J. Glesby, MD, Enzychem (Consultant)Gilead (Grant/Research Support)ReAlta Life Sciences (Consultant)Regeneron (Consultant, Grant/Research Support)Sobi (Consultant)Springer (Other Financial or Material Support, Royalties)UpToDate (Other Financial or Material Support, Royalties)

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S428-S429
Jessica Agnetti ◽  
Andrea C Büchler ◽  
Michael Osthoff ◽  
Fabrice Helfenstein ◽  
Vladimira Hinic ◽  

Abstract Background Rapid pathogen identification from positive blood cultures may help optimize empiric antibiotic therapy quickly by reducing unnecessary broad spectrum antibiotic use and may improve patient outcomes. The BioFire® FilmArray® Blood Culture Identification Panel 1 (BF-FA-BCIP) identifies 24 pathogens directly from positive blood cultures without subculture. 3 resistance genes are included. We aimed to compare the time to optimal antibiotic therapy between BF-FA-BCIP and conventional identification. Methods We performed a single-center retrospective case-control before-after study of 386 cases (November 2018 to October 2019) with BF-FA-BCIP compared to 414 controls (August 2017 to July 2018) with conventional identification. The primary study endpoint was the time from blood sampling to implementation of optimal antimicrobial therapy. Secondary endpoints were time to effective therapy, length of hospital stay, and in-hospital and 30-day mortality. Outcomes were assessed using cause-specific Cox Proportional Hazard models and logistic regressions. Results We included 800 patients with comparable baseline characteristics. Main sources of blood stream infection (BSI) were urinary tract infection and intra-abdominal infection (19.2% vs. 22.0% and 16.8% vs. 15.7% for case and control groups, respectively). Overall, 212 positive blood cultures were considered as contaminations. Identification results were available after a median of 21.9 hours by the BF-FA-BCIP and 44.3 hours by the conventional method. Patients with BF-FA-BCIP received the optimal therapy after a median of 25.5 hours (95%CI 21.0 - 31.2) as compared to 45.7 hours (95%CI 37.7 - 51.2) in the control group (Figure 1). We found no effect of the identification method on secondary outcomes. Kaplan-Meier curve representing the probability of implementing the optimal therapy at any given time according to the identification method (Standard vs. BF-FA-BCIP). Shaded ribbons represent the 95 % confidence interval (CI). The vertical dashes represent censored data. The vertical dotted lines represent the median time, i.e. the time at which 50 % of the patients obtained the optimal therapy, for the two methods. Median (95 % CI) time to optimal therapy is 45.7 (37.7 - 51.4) hours with the Standard method and 25.5 (21.0- 31.2) hours with Biofire. The tables below the curves present the numbers expecting optimal therapy according to the bacteria identification method, as well as the number of censored data in parenthesis. Panel A shows data from 0 to 900 hours. Panel B shows the data from 0 to 90 hours to better visualize how the probability to implement optimal therapy varies in the first 72 hours. Conclusion In conclusion, rapid pathogen identification by BF-FA-BCIP was associated with an almost 24h earlier initiation of the optimal antibiotic therapy in BSI. However, the overall benefit for individual patients seems to be limited. Future studies should assess the cost-effectiveness and impact on the prevention of antibiotic resistance using this diagnostic approach. Disclosures All Authors: No reported disclosures

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