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Background Matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry decreases time to identification (ID) and has been shown to improve antibiotic utilization when combined with real-time AS intervention. We assessed the impact of MALDI-TOF without additional AS support in patients with inpatient pneumonia. Methods This was a single-center quasi-experimental study of adult patients with a pneumonia who had a positive respiratory culture with bacteria that were identified by MALDI-TOF from August 2016–February 2017 (Pre-MALDI-TOF) and August–February 2018 (Post-MALDI-TOF). The primary endpoint was the time to initiation of optimal therapy before and after MALDI-TOF. The secondary endpoints included: clinical cure at 7 days; inpatient antibiotic duration; infection-related length of stay (LOS); overall LOS; excess antibiotic days; and costs. T-tests, Mann–Whitney U, and chi-squared tests were used for comparisons where appropriate. Results Table 1: Time to Optimal Therapy and Intervention Opportunities Pre-MALDI-TOF (180) Post-MALDI-TOF (180) P-Value Total opportunities for interventions, n (%) 152 (84) 168 (93) 0.007 De-escalation performed, n/N (%) 105/152 (69) 124/152 (74) 0.40 Escalation performed, n/N (%) 29/152 (19) 34/152 (20) 0.79 Time to Identification, h, median, IQR 63 [46–72] 32 [24–46]