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Due to enterococci intrinsic resistance, empiric antibiotic therapy is often inappropriate and early identification becomes crucial. Our objective was to assess the clinical impact of MALDI-TOF identification directly from positive blood cultures (BC) in <jats:italic>Enterococcus<\/jats:italic> spp. BSI (E-BSI).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A retrospective cohort study included all adult patients with E-BSI from 2010 to 2017 in a tertiary hospital. ID consultation within 48\u00a0h and MALDI-TOF identification directly from BC within 24\u00a0h were inclusion criteria. The primary outcome was antimicrobial treatment change following MALDI-TOF and secondary outcomes included 30-day and 1-year mortality, length of stay (LOS) and antimicrobial de-escalation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Among 267 BSI episodes, <jats:italic>E. faecalis<\/jats:italic> was isolated in 130 episodes (48.7%), <jats:italic>E. faecium<\/jats:italic> in 122 (45.7%), and 104 (39%) were polymicrobial. Empiric antibiotic therapy was inappropriate in 60.3% of patients. The LOS was 36 (IQR 20\u201364) days, 30-day and 1-year mortality were 16.1% and 43.4%, respectively. Enterococci identification with MALDI-TOF at the species level was possible in 66.3% cases and in 73% of monomicrobial cases. Antibiotics were changed in 85.3% of the former vs. 63.3% in remaining patients (<jats:italic>p<\/jats:italic>\u2009&lt;\u200910<jats:sup>\u2212\u20094<\/jats:sup>), and de-escalation occurred in 35% of subjects (vs. 12.2%,<jats:italic>p<\/jats:italic>\u2009=\u200910<jats:sup>\u2212\u20094<\/jats:sup>). Changing antibiotics after correct identification was associated with a shorter LOS. In multivariate analysis, appropriate antibiotic therapy before MALDI-TOF was protective against 30-day mortality (aOR 0.40(0.08\u20131.96)), and appropriate antibiotic therapy afterwards against 1-year mortality (aOR 0.21(0.05\u20130.84)).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>In E-BSI, direct MALDI-TOF identification from positive BC has a significant clinical impact due to a more frequent antibiotic spectrum correction and de-escalation. This may improve patient outcomes, reducing LOS and potentially mortality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical trial number<\/jats:title>\n            <jats:p>Not applicable.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10096-025-05084-x","type":"journal-article","created":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T11:50:44Z","timestamp":1741434644000},"page":"1185-1196","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of rapid identification by MALDI-TOF MS from positive blood cultures in Enterococcus spp. bloodstream infections"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9634-7900","authenticated-orcid":false,"given":"Diogo","family":"Lopes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1115-872X","authenticated-orcid":false,"given":"Bruno","family":"Grandbastien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Orasch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9529-3317","authenticated-orcid":false,"given":"Gilbert","family":"Greub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3512-8867","authenticated-orcid":false,"given":"Antony","family":"Croxatto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Prod\u2019Hom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6526-0714","authenticated-orcid":false,"given":"Benoit","family":"Guery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,8]]},"reference":[{"key":"5084_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/ice.2019.296","volume":"41","author":"LM Weiner-Lastinger","year":"2020","unstructured":"Weiner-Lastinger LM, Abner S, Edwards JR, Kallen AJ, Karlsson M, Magill SS et al (2020) Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: summary of data reported to the National healthcare safety network, 2015\u20132017. 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