Impact of MALDI-TOF implementation and antimicrobial stewardship programs on the optimization of antibiotic therapy...

Rapid pathogen identification is key in the management of bloodstream infections. Antimicrobial stewardship programs (ASPs) have been shown to reduce resistance, adverse effects, and healthcare costs. MALDI-TOF MS enables fast and accurate microbial identification. This study evaluates the impact of its implementation on antibiotic therapy adequacy and mortality in Staphylococcus aureus bacteremia.

A quasi-experimental pre-post study was conducted at a university hospital, covering two periods: June 2015/April 2017 (pre) and June 2021/April 2023 (post). The impact of MALDI-TOF on antibiotic adequacy and mortality was analyzed.

A total of 176 episodes were included (85 pre, 91 post). No significant epidemiological differences were observed between groups, although higher rates of sepsis and septic shock were noted in the post phase. MALDI-TOF was associated with improved antibiotic adjustment (3.51 vs. 1.75 days; P < .001). A non-significant trend toward lower early mortality was observed in the post-intervention group (P = .06). Mortality was associated with higher comorbidity (Charlson index), sepsis/septic shock, and MRSA bacteremia.

The implementation of MALDI-TOF, in conjunction with a multidisciplinary ASP, enhances early adjustment of empirical antibiotic therapy and may be associated with reduced early mortality in S. aureus bacteremia. Incorporating rapid diagnostics, especially for MRSA detection, is a key strategy to improve clinical outcomes.