Learning Objective: Describe the impact of rapid molecular blood culture diagnostics on antimicrobial optimization and stewardship interventions in adult patients with bloodstream infections.
Background: Bloodstream infections are associated with increased morbidity and mortality, and delays in therapy worsen outcomes. Blood culture identification (BCID) panel implementation, with antimicrobial stewardship, may shorten time to therapy optimization.
Methods: This retrospective, pre–post cohort study evaluated adult patients aged 18 years or older admitted to WellSpan York Hospital with at least one positive blood culture in September 2023 (pre-BCID implementation) or September 2025 (post-BCID implementation). The primary outcome was time to appropriate antimicrobial therapy. Secondary outcomes included time to first antimicrobial change, time to antimicrobial escalation or de-escalation, days of therapy, and the number, type, and timing of pharmacist-driven antimicrobial interventions, as well as hospital length of stay and in-hospital mortality.
Results: A total of 109 patients were included (52 pre-BCID implementation, 57 post-BCID implementation) with similar baseline characteristics between groups. There was no difference in time to appropriate antimicrobial therapy (0 vs. 0 hours, p=0.746). Time to first antimicrobial change was significantly reduced (36.2 vs. 12.1 hours, p=0.007), with faster de-escalation (43.7 vs. 18.6 hours, p=0.016) but no difference in time to escalation (27.4 vs. 4.4 hours, p=0.342). Pharmacist interventions increased, with shorter time to intervention (39.2 vs. 13.6 hours, p=0.045). No differences were observed in days of therapy, hospital length of stay, or in-hospital mortality.
Conclusion: Implementation of a BCID panel improved the timeliness of antimicrobial optimization, including faster de-escalation and pharmacist-driven interventions. Despite these improvements, no differences were observed in time to appropriate antimicrobial therapy, time to escalation, or clinical outcomes. These findings suggest empiric regimens, guided by local antibiograms and institutional protocols, were generally appropriate, with BCID further enhancing timely antimicrobial optimization.
Self-Assessment Question: A hospitalized adult is started empirically on vancomycin and cefepime for suspected bacteremia. Rapid BCID panel results return. In which scenario should rapid identification prompt an urgent change in antimicrobial therapy? A. MSSA identified; patient receiving vancomycin and cefepime B. E. coli identified; patient receiving vancomycin and cefepime C. MRSA identified; patient receiving vancomycin and cefepime D. Candida glabrata identified; patient receiving vancomycin and cefepime
