Rapid Test Method Research Articles

Rapid antimicrobial susceptibility testing by stimulated Raman scattering metabolic imaging and morphological deformation of bacteria

Methods for rapid antimicrobial susceptibility testing (AST) are urgently needed to address the emergence and spread of antimicrobial resistance. Here, we report a new method based on stimulated Raman scattering (SRS) microscopy, which measures both the metabolic activity and the morphological deformation of bacteria to determine the antimicrobial susceptibility of β-lactam antibiotics rapidly. In this approach, we quantify single bacteria's metabolic activity by the carbon-deuterium (C−D) bond concentrations in bacteria after D2O incubation. In the meantime, bacterial morphological deformation caused by β-lactam antibiotics is also measured. With these two quantifiable markers, we develop an evaluation method to perform AST of cefotaxime on 103 E. coli strains. Our method achieved a 93.2% categorical agreement and a 93.2% essential agreement with the standard reference method.

A fluorescence aptasensor based on controlled zirconium–based MOFs for the highly sensitive detection of T–2 toxin

T–2 toxin is one of class A trichothecene mycotoxins produced by Fusarium, presenting genotoxic, cytotoxicity, and immunotoxicity for animals and humans. Therefore, It is urgent to establish a rapid test method with high sensitivity, good selectivity and reliability. In this research, by adjusting the synthesis conditions, a kind of NH2–UiO–66 with high quenching efficiency was screened out. On this basis, we constructed a novel fluorescence sensor via Cy3–labeled aptamer (Cy3–aptamer). With the help of π–π interaction, hydrogen bond and coordination, NH2–UiO–66 could adsorb and quench the fluorescence of Cy3–aptamer based on FRET and PET. In the presence of T–2 toxin, it recognized and bound to Cy3–aptamer, leading to the disintegration of the NH2–UiO–66/Cy3–aptamer compound. As the energy transfer process was blocked, the fluorescence intensity was restored, enabling a highly sensitive response to T–2 toxin. There was a good linear correlation between fluorescence intensity and T–2 toxin concentration in the range of 0.5–100 ng ml −1. The LOD of this fluorescence aptasensor was 0.239 ng ml−1 (S/N = 3). Besides, the recoveries of milk and beer were 89.86–108.99% (RSD = 2.0–2.6%) and 92.31–111.51% (RSD = 2.3–2.9%), respectively. The fluorescence aptasensor exhibited advantages of excellent analytical performance, convenient operation procedure and good selectivity. Predictably, the aptasensor was supposed to detect antibiotics and other pollutants, describing an intriguing blueprint and potential application prospect in food safety, biochemical sensing and environmental conservation.

A Rapid and Sensitive Europium Nanoparticle-Based Lateral Flow Immunoassay Combined with Recombinase Polymerase Amplification for Simultaneous Detection of Three Food-Borne Pathogens.

Food-borne pathogens have become an important public threat to human health. There are many kinds of pathogenic bacteria in food consumed daily. A rapid and sensitive testing method for multiple food-borne pathogens is essential. Europium nanoparticles (EuNPs) are used as fluorescent probes in lateral flow immunoassays (LFIAs) to improve sensitivity. Here, recombinase polymerase amplification (RPA) combined with fluorescent LFIA was established for the simultaneous and quantitative detection of Listeria monocytogenes, Vibrio parahaemolyticus, and Escherichia coli O157:H7. In this work, the entire experimental process could be completed in 20 min at 37 °C. The limits of detection (LODs) of EuNP-based LFIA–RPA were 9.0 colony-forming units (CFU)/mL for Listeria monocytogenes, 7.0 CFU/mL for Vibrio parahaemolyticus, and 4.0 CFU/mL for Escherichia coli O157:H7. No cross-reaction could be observed in 22 bacterial strains. The fluorescent LFIA–RPA assay exhibits high sensitivity and good specificity. Moreover, the average recovery of the three food-borne pathogens spiked in food samples was 90.9–114.2%. The experiments indicate the accuracy and reliability of the multiple fluorescent test strips. Our developed EuNP-based LFIA–RPA assay is a promising analytical tool for the rapid and simultaneous detection of multiple low concentrations of food-borne pathogens.

Cholera Outbreak in Hadhramout, Yemen: The Epidemiological Weeks 2019

Background and aims: Cholera is a disease of acute watery diarrhea caused by Vibrio cholerae usually transmitted through contaminated water. In this study, we collected and analyzed the related epidemiological data to determine cholera outbreak in Hadhramout, Yemen during the disease epidemic in 2019. Methods: A cross-sectional study was conducted according to screening rapid diagnostic and confirmatory laboratory culture testing methods for diagnosing clinically cholera cases. Results: Suspected cholera cases were tested by rapid diagnostic test (RDT) and 399 (50.5%) out of 794 cases were determined positive, and 76(9.6%) of them were confirmed by laboratory culture test (LCT) with statistically significant difference. Serotype V. cholerae O1 was also detected in patients’ diarrhea. Females were the most affected by the disease manifested in 201 (25.3%) and 43 (5.4%) when tested by RDT and LCT, respectively, with no statistically significant difference. The highest proportion of cholera cases (224) were reported in the age group less than 15 years (56.1%) with statistically significant difference when tested by RDT, and 45(13.3%) when tested by LCT with insignificant statistics difference. Hajr directorate was revealed to be the most affected with 242 (30.47%) followed by Mukalla city directorate with 108 (13.60%) when the cases were tested by RDT; while Hajr and Mukalla city directorates reported 55 (7.0%) and 15 (2.0%), respectively, when it was confirmed by LCT with a statistically significant difference. Conclusion: Severe cholera outbreak occurred during the epidemiological weeks in 2019 in Hadhramout coast. V. cholerae O1 serotype was the causative agent of cholera. Females and age group less than 15 years were the most affected by the disease. Hajr and Mukalla city directorates reported serious outbreak cholera cases.

Standards efforts and landscape for rapid microbial testing methodologies in regenerative medicine

The Standards Coordinating Body for Gene, Cell, and Regenerative Medicines and Cell-Based Drug Discovery (SCB) supports the development and commercialization of regenerative medicine products by identifying and addressing industry-wide challenges through standards. Through extensive stakeholder engagement, the implementation of rapid microbial testing methods (RMTMs) was identified as a high-priority need that must be addressed to facilitate more timely release of products. Since 2017, SCB has coordinated efforts to develop standards for this area through surveys, weekly meetings, workshops, leadership in working groups and participation in standards development organizations. This article describes the results of these efforts and discusses the current landscape of RMTMs for regenerative medicine products.Based on discussions with stakeholders across the field, an overview of traditional culture-based methods and limitations, alternative microbial testing technologies and current challenges, fit-for-purpose rapid microbial testing and case studies, risk-based strategies for selection of novel rapid microbial test methods and ongoing standards efforts for rapid microbial testing are captured here. To this end, SCB is facilitating several initiatives to address challenges associated with rapid microbial testing for regenerative medicine products. Two documentary standards are under development: an International Organization for Standardization standard to provide the framework for a risk-based approach to selecting fit-for-purpose assays primarily intended for cell and gene therapy products and an ASTM standard guide focused on sampling methods for microbial testing methods in tissue-engineered medical products. Working with the National Institute of Standards and Technology, SCB expects to facilitate the process of developing publicly available microbial materials for inter-laboratory testing. These studies will help collect the data necessary to facilitate validation of novel rapid methods. Finally, SCB has been working to increase awareness of, dialog about and participation in efforts to develop standards in the regenerative medicine field.

Correlation of Rapid Electrochemical and Traditional Performance-Based Test Results for Assessing the Degree of Sulfate Resistance in Concrete

The aim of this study was to develop and propose classification criteria for practical assessment of concrete quality with a rapid sulfate resistance test. The rapid electrochemical sulfate resistance test based on ASTM C1202 has various advantages over the traditional performance test methods, such as short testing time, simple procedure, clear interpretation, and reasonable results. The proposed criteria were experimentally evaluated in both a series of laboratory test specimens and in specimens collected from various construction sites. The experimental results of the rapid electrochemical test and the traditional length change according to ASTM C1012 were correlated to develop performance specifications regarding ion sulfate penetration. The performance specifications proposed on the basis of this study have six levels of ion penetrability. The proposed performance specifications with rapid electrochemical test method are expected to lead to practical applications in the cement and concrete industries.

Recent Development of Rapid Antimicrobial Susceptibility Testing Methods through Metabolic Profiling of Bacteria.

Due to the inappropriate use and overuse of antibiotics, the emergence and spread of antibiotic-resistant bacteria are increasing and have become a major threat to human health. A key factor in the treatment of bacterial infections and slowing down the emergence of antibiotic resistance is to perform antimicrobial susceptibility testing (AST) of infecting bacteria rapidly to prescribe appropriate drugs and reduce the use of broad-spectrum antibiotics. Current phenotypic AST methods based on the detection of bacterial growth are generally reliable but are too slow. There is an urgent need for new methods that can perform AST rapidly. Bacterial metabolism is a fast process, as bacterial cells double about every 20 to 30 min for fast-growing species. Moreover, bacterial metabolism has shown to be related to drug resistance, so a comparison of differences in microbial metabolic processes in the presence or absence of antimicrobials provides an alternative approach to traditional culture for faster AST. In this review, we summarize recent developments in rapid AST methods through metabolic profiling of bacteria under antibiotic treatment.

Investigation of different permeability properties of self‐healing cementitious composites under colloidal nano silica curing conditions

AbstractIn this study, the self‐healing behavior of engineered cemetitious composites (ECC) containing different types and quantities of fly ash (FA) under colloidal nano silica (CNS) curing conditions was investigated through the examination of their different permeability properties. FA in two different characters, Class F and Class C, were used in the preparation of the mixtures in high volumes (FA/portland cement = 1.2 and 2.2). Self‐healing capacities developed under CNS curing conditions were evaluated by changes in different permeability properties such as rapid chloride permeability test (RCPT) and electrical impedance measurement methods. In addition to these, the self‐healing effects of the cracked composites were supported by microstructure analysis with the help of SEM–EDX and XRD tests on the sections taken from the crack interface of the sample. The results have showed that the CNS curing condition helps improve the permeability properties of composites by quickly and effectively covering their micro pores and cracks. In addition, the results of the experiment have revealed the effects of the use of different types and quantities of FA on the self‐healing behavior of the ECC material. Finally, correlation analysis of ECC samples was applied according to the results obtained from EI and RCPT test methods and it was revealed that there was a negative significant relationship between test methods.

Rapid Antimicrobial Susceptibility Testing Methods for Blood Cultures and Their Clinical Impact.

Antimicrobial susceptibility testing (AST) of bacteria isolated in blood cultures is critical for optimal management of patients with sepsis. This review describes new and emerging phenotypic and genotypic AST methods and summarizes the evidence that implementation of these methods can impact clinical outcomes of patients with bloodstream infections.

Low‐level determination of 4‐chlorobutyl‐(S)‐[4‐chloro‐2‐(4‐cyclopropyl‐1,1,1‐trifluoro‐2‐hydroxy‐but‐3yn‐2‐yl)phenyl] carbamate (4‐CTHC) in efavirenz drug substance by LC–MS

A rapid, simple, sensitive, and selective liquid chromatography-tandem mass spectrometry (LC-MS) test method was developed and validated for the trace level determination of 4-chlorobutyl-(S)-[4-chloro-2-(4-cyclopropyl-1,1,1-trifluoro-2-hydroxy-but-3yn-2-yl)phenyl] carbamate (4-CTHC). 4-CTHC is a potential genotoxic impurity in efavirenz drug substance and the acceptable level is 2.5 μg ml-1 with respect to analyte concentration according to ICH M7(R1) Multidisciplinary Guidelines M7(R1). The LC-MS/MS analysis of 4-CTHC impurity was carried out on a Kinetex C18 (150 × 4.6 mm, 5.0 μm) column. In this test procedure, the mobile phase was prepared with buffer (0.1% formic acid in water) and acetonitrile in the ratio of 1:3 (v/v). The method set flow rate was 0.4 ml min-1 . The method was developed with a short run time of <10 min. Selective ion monitoring acquisition mode and negative polarity electrospray ionization mode were used as an MS method to quantify genotoxic impurities at 422.25 Da. The method showed linearity in a range of 0.64-3.71 μg ml-1 with a correlation coefficient of 0.9992. The RSD for intra-day and inter-day precision was found to be <5%. The method's accuracy was in the range of 106.5-112.4% for the genotoxic impurity of 4-CTHC. The procedure was validated as per the current ICH Q2 (R1) guidelines and proved suitable for stability testing in the quality control laboratory for pharmaceutical preparations.

Development and validation of a liquid chromatographic tandem mass spectrometric method for the analysis of patulin in apple and apple juice.

This study reports a robust and sensitive method for rapid testing of patulin in apple and apple juice. The method involved extraction of homogenised samples (10g) with ethyl acetate (10mL) and clean up by dispersive-solid phase extraction using primary secondary amine (25mg/mL). Prior to the LC-MS/MS analysis, the cleaned extract was reconstituted in methanol/water (2:8). The optimised LC-MS condition provided a symmetric peak of patulin within a short LC-runtime of 5min. The recoveries at the limit of quantification (0.005mg/kg) and higher levels were satisfactory (> 80%), with the precision-RSDr (< 11%). In an inter-laboratory comparison study involving 13 accredited laboratories, the reproducibility-RSDR and HorRat values ranged between 4.80 and 6.08% and between 0.18 and 0.23 respectively, indicating a satisfactory method-precision. The z-scores of the participating laboratories were within ± 2. When the method was applied to incurred samples, the contamination range was 0.008-0.225mg/kg and 0.018-0.034mg/kg for apple and juice respectively, demonstrating a satisfactory performance in terms of precision. Based on the solvent standard, matrix-matched standard and standard-addition approaches, the calibration graphs provided similar quantitative performances. Because of its reliability, robustness and time-effectiveness, the method can be recommended for regulatory testing purposes.

Development of a rapid field testing method for metals in horizontal directional drilling residuals with XRF sensor

Portable X-ray fluorescence (pXRF) spectrometer allows fast in-situ elemental determination without wet digestion for soils or geological materials, but the use of XRF on wet materials is not well documented. Our objective was to develop a rapid field method using pXRF to measure metals in the residues from horizontal directional drilling (HDD) operations so that proper disposal decisions can be made in-situ. To establish the procedure, we spiked soil samples with 4 concentrations of Cr, Ni, Cu, Zn, As, Cd, and Pb up to 1000 mg kg−1, and then the metal concentrations were determined by wet chemical method after drying and acid digestion (standard method), and by pXRF, also at laboratory conditions, after drying and at two different moisture conditions. The measurements by pXRF and standard method after drying and after removal of excess water (AREW) were highly correlated with slopes ranging from 0.83 ± 0.01 to 1.08 ± 0.01 (P < 0.001) for all metals. The relationship was better AREW than the saturated paste without removal of excess water and the moisture content affected only the accuracy of As, Cd, and Pb. The procedure established was successfully used for HDD residues collected from 26 states of US with moisture content ranging from 14 to 83% AREW. The pXRF was proven to be a reliable tool for fast detection of common metals in dried soils and HDD residues, and samples containing < 30% moisture content without needing to correct for moisture. If the moisture is > 30%, excess water in samples need to be removed with a commercially available filter press to achieve high accuracy. The developed procedures reduce time of metal detection from days to about an hour which allows drilling operators to make quick decisions on soil or HDD disposal.

Factors influencing antimicrobial prescription attitudes in bloodstream infections: susceptibility results and beyond. An exploratory survey

Novel rapid antimicrobial susceptibility testing (RAST) methods promise quicker de-escalation of broad-spectrum antibiotics. However, other behavioural and situational factors influencing antimicrobial prescription are not well known. To explore factors associated with optimal antimicrobial prescription in patients with Gram-negative bloodstream infection and to propose specific scenarios in which a rapid antimicrobial susceptibility result may help to optimize prescribing. Exploratory survey (April-August 2018) in the UK and Spain using clinical case-related questions. Seniority, specialty and country of practice were recorded. Cases described patients with Gram-negative bloodstream infections, their empirical treatment and clinical course and the hypothetical RAST result. Respondents chose one of several options regarding antibiotic treatment management. Microbiologically optimal antibiotic choice (MOAC) was agreed by expert consensus beforehand. Responses were categorized as MOAC, request for support or sub-optimal choice. The relationship between the RAST result and the clinical course was defined as concordant (susceptible organism-clinical improvement; resistant organism-clinical deterioration) or as discordant otherwise. A total of 426 respondents (UK: 332; Spain: 94) and 1494 answers were analysed. Multivariate analysis identified that requests for support were 87% less likely in Spain; that antimicrobial resistance and clinical deterioration were associated with both increased request for support (odds ratio (OR) 7.66 and OR 4.26, respectively) and MOAC (OR 2.08 and OR 2.06, respectively). A discordant clinical course was associated with 82% lower odds for MOAC. Out-of-hours results, seniority and specialty did not have an effect. Antimicrobial choice is influenced by each country's type of practice, clinical course and susceptibility results. Antimicrobial resistance was associated with increased optimal treatment, suggesting RAST may be less useful for step-down decisions in settings with low baseline resistance rates.

Characterization of Precipitation in 7055 Aluminum Alloy by Laser Ultrasonics

After different rolling conditions, four 7055 aluminum alloy samples with different precipitation sizes were measured by scanning electron microscope, transmission electron microscope and laser ultrasonic. The attenuation coefficients of ultrasound measured by laser ultrasonic were calculated in the time domain, frequency domain and wavelet denoising, respectively. The relationship between the precipitate size and attenuation coefficient was established. The results show that the attenuation of the ultrasonic wave is related to the size of the precipitated phase; this provides a new method for rapid non-destructive testing of the precipitation of aluminum alloys.

Open-source RNA extraction and RT-qPCR methods for SARS-CoV-2 detection.

Re-opening of communities in the midst of the ongoing COVID-19 pandemic has ignited new waves of infections in many places around the world. Mitigating the risk of reopening will require widespread SARS-CoV-2 testing, which would be greatly facilitated by simple, rapid, and inexpensive testing methods. This study evaluates several protocols for RNA extraction and RT-qPCR that are simpler and less expensive than prevailing methods. First, isopropanol precipitation is shown to provide an effective means of RNA extraction from nasopharyngeal (NP) swab samples. Second, direct addition of NP swab samples to RT-qPCRs is evaluated without an RNA extraction step. A simple, inexpensive swab collection solution suitable for direct addition is validated using contrived swab samples. Third, an open-source master mix for RT-qPCR is described that permits detection of viral RNA in NP swab samples with a limit of detection of approximately 50 RNA copies per reaction. Quantification cycle (Cq) values for purified RNA from 30 known positive clinical samples showed a strong correlation (r2 = 0.98) between this homemade master mix and commercial TaqPath master mix. Lastly, end-point fluorescence imaging is found to provide an accurate diagnostic readout without requiring a qPCR thermocycler. Adoption of these simple, open-source methods has the potential to reduce the time and expense of COVID-19 testing.

A novel concentration gradient microfluidic chip for high-throughput antibiotic susceptibility testing of bacteria.

Antibiotic resistance has become a serious threat to food safety and public health globally. Therefore, the development of a sensitive, quick, and simple method for antibiotic susceptibility testing is an urgent and crucial need. A novel concentration gradient microfluidic chip was designed in this work to generate antibiotic concentration gradient, culture bacteria, and produce fluorescence emission. An in-house-assembled fluorescence detection platform was constructed, and experiments were conducted to verify the linearity of the generated concentration gradient, explore the appropriate incubation time and flow rate for the microfluidic chip, and study the effect of long-term acid-based food processing on antibiotic susceptibility testing. Experimental results show that the concentration gradient generated by the microfluidic chip exhibited good linearity, stability, and controllability. The appropriate flow rate and incubation time for the microfluidic chip were 2μL/min and 5 h, respectively. The use of this microfluidic chip for testing antibiotic resistance of Salmonella to ofloxacin and ampicillin generated results that were completely consistent with test results obtained using the gold-standard method. Furthermore, Salmonella showed greater sensitivity to antibiotics under strong acid conditions, confirming the potential influence of acid-based food processing on antibiotic susceptibility testing of real samples. The designed microfluidic chip provides a high-throughput, sensitive, and rapid antibiotic susceptibility testing method that combines the microfluidic chip and the fluorescence detection platform. The application of this method would facilitate determination of antibiotic-resistant bacterial strains for clinicians and researchers, and enable monitoring of changes in bacterial resistance during food processing.

First Report on the Rapid Detection and Identification of Methicillin-Resistant Staphylococcus aureus (MRSA) in Viable but Non-culturable (VBNC) Under Food Storage Conditions.

Formation of viable but non-culturable (VBNC) status in methicillin-resistant Staphylococcus aureus (MRSA) has never been reported, and it poses a significant concern for food safety. Thus, this study aimed to firstly develop a rapid, cost-effective, and efficient testing method to detect and differentiate MRSA strains in the VBNC state and further apply this in real food samples. Two targets were selected for detection of MRSA and toxin, and rapid isothermal amplification detection assays were developed based on cross-priming amplification methodology. VBNC formation was performed for MRSA strain in both pure culture and in artificially contaminated samples, then propidium monoazide (PMA) treatment was further conducted. Development, optimization, and evaluation of PMA-crossing priming amplification (CPA) were further performed on detection of MRSA in the VBNC state. Finally, application of PMA-CPA was further applied for detection on MRSA in the VBNC state in contaminated food samples. As concluded in this study, formation of the VBNC state in MRSA strains has been verified, then two PMA-CPA assays have been developed and applied to detect MRSA in the VBNC state from pure culture and food samples.

Rapid Evaluation Method for Accuracy of Range Estimation of Pure Electric Vehicle Range Estimation Based on CLTC-P

Based on theoretical and experimental research, this paper constructs a rapid test method for estimating the accuracy of the range of pure electric vehicles based on CLTC-P, which is based on different environmental temperatures, air conditioning use, test scenarios, and high-speed operating conditions. The article further compares and analyzes a variety of mathematical statistical methods and selects certain coefficients to evaluate the accuracy of cruising range estimation, and proposes a general rapid test method and evaluation theory of cruising range estimation accuracy, which lays the foundation for establishing a unified assessment standard in industry, and promotes the development of the electric vehicle industry.

Transfusion Related Hepatitis C Virus Antibodies and Possible Risk Factors in Healthy Blood Donors.

The main cause of transfusion associated hepatitis, cirrhosis and hepatocellular carcinoma is HCV infection. The present research was carried out to investigate the outbreak extent of anti–HCV antibodies among healthy blood donors attending the transfusion department at Khartoum hospitals. 3000 volunteer healthy blood donors participated in a cross–sectional study. Rapid test method was applied and positive samples were approved with the ELISA (fourth generation). SPSS software version 26 was used for statistical analysis of data. 0.5% of the research population was detected to have anti-HCV antibody. Donors (all male) were between 19–46 years old with mean age (1.95± 0.421SD). 2545 (84.8%) were volunteer, 455 (15.1%) were family replacement donors, 11 (0.36%) were positive among volunteer group, and most of the participants (0.16%) who were diagnosed with hepatitis C antibodies had history of cupping. 2265 (75%) of donors had a history of jaundices; only 13 (0.6%) statistically carried antibodies against HCV (P value 0.012). Sudanese blood donors had a low seroprevalence of hepatitis C virus; however, the existence of the virus and the likelihood of transmission and dissemination were confirmed. Hence, very rigorous guidelines are necessary for selecting blood donors. Furthermore, laboratory diagnostic tests for identifying infectious agents must be significantly enhanced

313. Using a Clinical Decision Prediction Tool to Improve Empirical Antimicrobial Therapy in Ceftriaxone-Resistant Enterobacterales Bloodstream Infections

BackgroundThere are several clinical tools for prediction of antimicrobial resistance. However, their utility in management of bloodstream infections (BSI) due to resistant bacteria remains unclear. This quasi-experimental cohort examined the impact of utilization of the extended-spectrum beta-lactamase (ESBL) prediction score on time to initiation of appropriate antimicrobial therapy (AAT) in BSI due to ceftriaxone-resistant (CRO-R) Enterobacterales.MethodsAdults with first episodes of monomicrobial BSI due to CRO-R Enterobacterales at Prisma Health-Midlands Hospitals in South Carolina from January 2010 to December 2017 were included. Antimicrobial stewardship intervention was implemented in January 2014 consisting of real-time alerts for positive blood cultures and rapid diagnostics for identification of bloodstream isolates. The ESBL prediction score was used to stratify risk of resistance prior to conventional antimicrobial susceptibility results. Student’s t-test was used to compare mean time to AAT before and after intervention.ResultsAmong 92 patients with BSI due to CRO-R Enterobacterales, median age was 66 years, 52 (57%) were men, 68 (74%) had community-onset BSI, and 52 (57%) had urinary source of infection. Escherichia coli 52 (57%) and Klebsiella species 27 (29%) were the most common bloodstream isolates and the majority 63 (68%) produced ESBLs. There were no significant differences in demographics or clinical characteristics of patients before (n=45) and after (n=47) antimicrobial stewardship intervention. Mean time to AAT was 3.2 days prior and 1.7 days after utilization of ESBL prediction score (p=0.021). Results were consistent among ESBL-producing Enterobacterales (time to AAT 2.8 before and 1.8 days after intervention, p=0.025).ConclusionUtilization of the ESBL prediction score as part of a real-time antimicrobial stewardship intervention significantly reduced time to AAT in BSI due to CRO-R and ESBL-producing Enterobacterales. The ESBL prediction score represents a viable tool to improve antimicrobial management in clinical settings that lack access to multiplex PCRs for detection of antimicrobial resistance genes and novel methods for rapid phenotypic antimicrobial susceptibility testing.DisclosuresJulie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)TRC Healthcare (Speaker’s Bureau)