OBJECTIVES: To measure the cost impact of the delay of broad spectrum antibiotics de-escalation on surgical wards at a tertiary care center in Jeddah, Saudi Arabia  METHODS: Retrospective cohort study for patients admitted to surgical wards at a tertiary care center in Jeddah, Saudi Arabia over 3 months. Three broad spectrum antibiotics were targeted; piperacillin/tazobactam, imipenem, and meropenem. De-escalation delay was measured in days from the time of getting the culture identification and susceptibility until narrowing the antimicrobial therapy to target the identified organism. The cost impact was measured by multiplying the period that patients were on broad spectrum antibiotics after the final identification and susceptibility of microorganism by the cost of broad-spectrum antibiotics per day.    RESULTS: One hundred sixty-three patients received broad spectrum antibiotics over 3 months on surgical wards at our institution. Sixty four out 163 patient (39.2%) had identified organism and susceptibility for other antibiotics. Thirty one patients (48.4%) had de-escalation of antimicrobial therapy within 24 hrs of culture identification and susceptibility result.  Thirty three patients (51.6%) had a delay in their broad spectrum antibiotics therapy de-esclation despite getting the culture identification and susceptibility. The total delay of broad spectrum antibiotics and cost impact were as follow: piperacillin/tazobactam 267 days (3,920 USD); imipenem 5 days (230 USD); meropenem 110 days (9,925 USD).   CONCLUSIONS: the delay of broad spectrum antibiotics de-escalation on surgical wards at our hospital has resulted in a cost impact of 14,075 USD over 3 months period. Pharmacy intervention program on surgical wards to enforce the de-escalation process is needed.