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Background Accelerate Pheno blood culture detection system (AXDX) provides rapid identification and antimicrobial susceptibility testing results. Limited data exist regarding its clinical impact. Other rapid platforms coupled with antimicrobial stewardship program (ASP) real-time notification (RTN) have shown improved length of stay (LOS) in bacteremia. Methods A single-center, quasi-experimental study of bacteremic inpatients before and after AXDX implementation was conducted comparing clinical outcomes from 1 historical and 2 intervention cohorts (AXDX and AXDX + RTN). Results Of 830 bacteremic episodes, 188 of 245 (77%) historical and 308 (155 AXDX, 153 AXDX + RTN) of 585 (65%) intervention episodes were included. Median LOS was shorter with AXDX (6.3 days) and AXDX + RTN (6.7 days) compared to historical (8.1 days) (P =.001). In the AXDX and AXDX + RTN cohorts, achievement of optimal therapy (AOT) was more frequent (93.6% and 95.4%, respectively) and median time to optimal therapy (TTOT) was faster (1.3 days and 1.4 days, respectively) compared to historical (84.6%, P ≤.001 and 2.4 days, P ≤.001, respectively). Median antimicrobial days of therapy (DOT) was shorter in both intervention arms compared to historical (6 days each vs 7 days; P =.011). Median LOS benefit during intervention was most pronounced in coagulase-negative Staphylococcus bacteremia (P =.003). Conclusions LOS, AOT, TTOT, and total DOT significantly improved after AXDX implementation. Addition of RTN did not show further improvement over AXDX and an already active ASP. These results suggest that AXDX can be integrated into healthcare systems with an active ASP even without the resources to include RTN. [ABSTRACT FROM AUTHOR]

Background Accelerate Pheno™ blood culture detection system (AXDX) provides identification (ID) and antimicrobial susceptibility testing (AST) within 8 hours of growth in blood culture. We previously reported length of stay (LOS), time to optimal therapy (TTOT), and antibiotic days of therapy (DOT) decrease following AXDX implementation alongside an active antimicrobial stewardship program (ASP). It is unclear whether real-time notification (RTN) of results further improves these variables. Methods A single-center, quasi-experimental before/after study of adult bacteremic inpatients was performed after implementation of AXDX. A 2017 historical cohort was compared with two 2018 intervention cohorts. Intervention-1: AXDX performed 24/7 with results reviewed by providers or ASP as part of their normal workflow. Intervention 2: AXDX performed 24/7 with RTN to ASP 7 days per week 9a-5p and overnight results called to ASP at 9a. Interventions 1 and 2 were utilized on an alternating weekly basis during the study (February 2018–September 2018). Historical ID/AST were performed using VITEK® MS and VITEK®2. Exclusion criteria included polymicrobial or off-panel isolates, prior positive culture, and patients not admitted at the time of AST. Clinical outcomes were compared with Wilcoxon rank-sum and χ 2 analysis. Results 540 (83%) of 650 positive cultures performed on AXDX had on-panel organisms. 308 (57%) of these cultures and 188 (77%) of 244 reviewed historical cultures met inclusion criteria. Baseline illness severity and identified pathogens were similar between cohorts. Clinical outcomes and antimicrobial DOT are reported in Tables 1 and 2. Conclusion Following our implementation of AXDX, clinical outcomes including LOS, TTOT, total DOT, BGN DOT, and frequency of achieving optimal therapy were significantly improved compared with a historical cohort. Addition of RTN for AXDX results in the setting of an already active ASP did not further improve these metrics. However, compared with historical arm, AXDX with RTN did significantly impact specific subsets of antibiotic use while AXDX alone did not. This may be due to earlier vancomycin de-escalation. These results support the benefit of integration of AXDX into healthcare systems with an active ASP even without the resources to include real-time notification. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]