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Background and Importance Bloodstream infections (BSI) are associated with high morbidity and mortality, requiring prompt and appropriate antimicrobial therapy. Antimicrobial Stewardship Programmes (ASPs) review positive blood cultures daily and provide recommendations to optimise treatment.Aim and Objectives Evaluate the impact of ASP interventions on optimising antimicrobial treatment in patients with BSI. To this end, we assessed the acceptance rate of ASP recommendations and analysed the association between acceptance (yes/no) and clinical outcomes: 30-day mortality, ICU admission, and hospital readmission.Material and Methods We conducted a retrospective observational study over four months (April–July 2025) in a tertiary care hospital. All episodes of BSI confirmed by blood culture were included. ASP interventions were prospectively recorded in an Excel database (type of recommendation, communication method, and acceptance). Demographic, clinical, microbiological, therapeutic, and outcome variables were retrospectively extracted from the electronic medical record.Statistical analysis was performed using Excel . Descriptive statistics (means ± SD or medians [IQR] for continuous variables, percentages for categorical variables) and comparisons between groups were performed.Results The study analysed 78 BSI episodes, predominantly in males (48) and the elderly (median age 76). The main origin was community (31), and the most frequent focus was Urinary (42%, 33). Most cases presented with severe infection (sepsis/septic shock: 32). The most isolated pathogens were E. coli (13) and K. pneumoniae (9). A high rate of MDR pathogens (31 isolates) was observed, primarily due to extended-spectrum beta-lactamase-producing bacteria (16). Notably, initial empirical treatment was inappropriate in the majority (47 vs. 31).The ASP intervened in all 78 episodes, achieving an excellent 88% acceptance rate. The most common recommendations were escalation (63%) or de-escalation (32%) of therapy. Despite the high intervention acceptance, the overall 30-day mortality was 16.7% (13 deaths), ICU admission occurred in 9 patients, and hospital readmission within 30 days affected 10 patients (12.8%).Conclusion and Relevance ASP interventions are highly accepted and important for optimising antimicrobial therapy in patients with BSI, especially given the high rate of initial inappropriate treatment and MDR pathogens. Thirty-day mortality (16.7%) was similar to García-Rodríguez et al. (17.4%), while 30-day readmission (12.8%) was lower than Gradel et al. (31.3%).References and/or Acknowledgements 1. García-Rodríguez JF, et al. 2023. https://doi.org/10.1186/s12879-023-08018-02. Gradel K, et al. 2025. https://doi.org/10.1007/s10096-025-05347-7Conflict of Interest No conflict of interest