Microbiology laboratories where MALDI-TOF MS is available can benefit from its capacity to identify most clinically interesting non-tuberculous mycobacteria in a rapid, reliable, and inexpensive manner.
Microbiological confirmation of a urinary tract infection (UTI) takes 24–48 h. In the meantime, patients are usually given empirical antibiotics, sometimes inappropriately. We assessed the feasibility of sequentially performing a Gram stain and MALDI-TOF MS mass spectrometry (MS) on urine samples to anticipate clinically useful information. In May-June 2012, we randomly selected 1000 urine samples from patients with suspected UTI. All were Gram stained and those yielding bacteria of a single morphotype were processed for MALDI-TOF MS. Our sequential algorithm was correlated with the standard semiquantitative urine culture result as follows: Match, the information provided was anticipative of culture result; Minor error, the information provided was partially anticipative of culture result; Major error, the information provided was incorrect, potentially leading to inappropriate changes in antimicrobial therapy. A positive culture was obtained in 242/1000 samples. The Gram stain revealed a single morphotype in 207 samples, which were subjected to MALDI-TOF MS. The diagnostic performance of the Gram stain was: sensitivity (Se) 81.3%, specificity (Sp) 93.2%, positive predictive value (PPV) 81.3%, negative predictive value (NPV) 93.2%, positive likelihood ratio (+LR) 11.91, negative likelihood ratio (−LR) 0.20 and accuracy 90.0% while that of MALDI-TOF MS was: Se 79.2%, Sp 73.5, +LR 2.99, −LR 0.28 and accuracy 78.3%. The use of both techniques provided information anticipative of the culture result in 82.7% of cases, information with minor errors in 13.4% and information with major errors in 3.9%. Results were available within 1 h. Our serial algorithm provided information that was consistent or showed minor errors for 96.1% of urine samples from patients with suspected UTI. The clinical impacts of this rapid UTI diagnosis strategy need to be assessed through indicators of adequacy of treatment such as a reduced time to appropriate empirical treatment or earlier withdrawal of unnecessary antibiotics.
IntroductionMALDI-TOF MS represents a new technological era for microbiology laboratories. Improved sample processing and expanded databases have facilitated rapid and direct identification of microorganisms from some clinical samples. Automated analysis of protein spectra from different microbial populations is emerging as a potential tool for epidemiological studies and is expected to impact public health.AimTo demonstrate how implementation of MALDI-TOF MS has changed the way microorganisms are identified, how its applications keep increasing and its impact on public health and hospital hygiene.MethodsA review of the available literature in PubMED, published between 2009 and 2018, was carried out.ResultsOf 9,709 articles retrieved, 108 were included in the review. They show that rapid identification of a growing number of microorganisms using MALDI-TOF MS has allowed for optimisation of patient management through prompt initiation of directed antimicrobial treatment. The diagnosis of Gram-negative bacteraemia directly from blood culture pellets has positively impacted antibiotic streamlining, length of hospital stay and costs per patient. The flexibility of MALDI-TOF MS has encouraged new forms of use, such as detecting antibiotic resistance mechanisms (e.g. carbapenemases), which provides valuable information in a reduced turnaround time. MALDI-TOF MS has also been successfully applied to bacterial typing.ConclusionsMALDI-TOF MS is a powerful method for protein analysis. The increase in speed of pathogen detection enables improvement of antimicrobial therapy, infection prevention and control measures leading to positive impact on public health. For antibiotic susceptibility testing and bacterial typing, it represents a rapid alternative to time-consuming conventional techniques.
e Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has demonstrated its ability to promptly identify nontuberculous mycobacteria using the Mycobacteria Library v2.0. However, some species are particularly difficult to identify reliably using this database, providing a low log(score). In this study, the identification power of an updated Mycobacteria Library (v3.0) has been evaluated. Overall, 109 NTM isolates were analyzed with both databases. The v3.0 database allowed a high-level confidence in the identification [log(score) value, >1.8] of 91.7% of the isolates versus 83.5% with the v2.0 version (P < 0.01). Rapid identification of nontuberculous mycobacteria (NTM) with matrix-assisted laser desorption-ionization time of flight mass spectrometry (MALDI-TOF MS) has outperformed molecular techniques, such as GenoType (Hain Lifescience GmbH, Nehren, Germany), and provides accurate identification that correlates well with 16S rRNA gene sequencing when applied to the most common species of NTM (1-3). The Mycobacteria Library database (Bruker Daltonik GmbH, Bremen, Germany) available so far (v2.0) provided low scores, particularly for NTM belonging to the slow-growing groups (3-5). In the present study, we assessed the power of a new database to identify NTM (i.e., Mycobacteria Library v3.0) using 109 isolates from 26 NTM species (Table 1) and compared the identification scores of version v2.0 and version v3.0.Ninety-nine nonselected NTM isolates from clinical samples and 10 reference strains (Table 1) were collected in the clinical microbiology laboratory from the Hospital Gregorio Marañón (Madrid, Spain) between January 2011 and May 2015. These isolates were routinely identified by 16S rRNA hsp65 sequencing and, in parallel, by MALDI-TOF MS using a Microflex LT benchtop mass spectrometer (Bruker Daltonik) and the Mycobacteria Library v2.0, containing 313 Mycobacterium isolates from 131 species (Bruker Daltonik) (4). Sample preparation was described elsewhere (6). Briefly, colonies of NTM isolates grown on Lowenstein-Jensen medium were harvested into a 1.5-ml Eppendorf tube with 300 l of deionized water and inactivated for 30 min at 95°C under biosafety level 3 conditions. Then, they were centrifuged at maximal speed and subsequently resuspended in 300 l of water and 900 l of absolute ethanol and centrifuged again at 13,000 rpm. The supernatant was discarded, and the pellet was taken to biosafety level 2 conditions in order to disrupt the mycobacteria cell aggregates with silica bead vortexing and extract the bacterial proteins using formic acid and acetonitrile. In the end, 1 l of supernatant was placed onto a steel plate for MALDI-TOF MS analysis. Samples were analyzed in duplicates; the species identification, using the Mycobacteria Library v2.0, and the higher log(score) value result were recorded. For comparison reasons, all of the protein spectra from the 109 NTM isolates were reanalyzed using the new Mycobacteria Library v3.0, containing 853 references from 149 Mycob...
showing azole resistance according to the EUCAST 9.3.2 methodology were molecularly identified and the cyp51A gene was studied in A. fumigatus sensu stricto isolates. Results: Eight hundred and forty-seven isolates from 725 patients were collected in 29 hospitals (A. fumigatus sensu stricto (n ¼ 828) and cryptic species (n ¼ 19)). Isolates were mostly from the lower respiratory tract (94.0%; 797/847). Only cryptic species were amphotericin B resistant. Sixty-three (7.4%) out of the 847 isolates were resistant to 1 azole(s). Azole resistance was higher in cryptic species than in A. fumigatus sensu stricto (95%, 18/19 vs. 5.5%, 45/828); isavuconazole was associated to the lowest number of non-wild type isolates. The dominant mechanism of resistance was the presence of TR 34 -L98H substitutions (n ¼ 24 out of 63). Out of the 725 patients, 48 (6.6%) carried either cryptic species (n ¼ 14) or A. fumigatus sensu stricto (n ¼ 34; 4.7%) resistant isolates. Aspergillus fumigatus sensu stricto harbouring either the TR 34 -L98H (n ¼ 19) or TR 46 /Y121F/T289A (n ¼ 1) mutations were detected in patients in hospitals located at 7/24 studied cities. Discussion: Of the patients, 6.6% carry azole-resistant A. fumigatus sensu lato isolates in Spain. TR 34 -L98H is the dominant cyp51A gene substitutions, although its presence is not widespread.
In recent years, matrix-assisted laser desorption-ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) has proved a rapid and reliable method for the identification of bacteria and yeasts that have already been isolated. The objective of this study was to evaluate this technology as a routine method for the identification of microorganisms directly from blood culture bottles (BCBs), before isolation, in a large collection of samples. For this purpose, 1000 positive BCBs containing 1085 microorganisms have been analysed by conventional phenotypic methods and by MALDI-TOF MS. Discrepancies have been resolved using molecular methods: the amplification and sequencing of the 16S rRNA gene or the Superoxide Dismutase gene (sodA) for streptococcal isolates. MALDI-TOF predicted a species- or genus-level identification of 81.4% of the analysed microorganisms. The analysis by episode yielded a complete identification of 814 out of 1000 analysed episodes (81.4%). MALDI-TOF identification is available for clinicians within hours of a working shift, as oppose to 18 h later when conventional identification methods are performed. Moreover, although further improvement of sample preparation for polymicrobial BCBs is required, the identification of more than one pathogen in the same BCB provides a valuable indication of unexpected pathogens when their presence may remain undetected in Gram staining. Implementation of MALDI-TOF identification directly from the BCB provides a rapid and reliable identification of the causal pathogen within hours.
Despite the benefits of MALDI-TOF MS technology (Matrix-Assisted Laser Desorption-Ionization Time-Of-Flight Mass Spectrometry) reported worldwide and the continuous improving of the available databases, discrimination between Streptococcus pneumoniae and closely related species within the Streptococcus mitis group (SMG) using this methodology has been suboptimal. However, the accurate identification at the species level of this group of microorganisms is important for the appropriate management of infected patients. In this study, 216 SMG isolates -101 S. pneumoniae and 115 corresponding to 7 non-pneumococcal species within this group- were analyzed. All the isolates had been previously identified by conventional methods (optochin and bile solubility tests) and non-pneumococcal isolates were confirmed by sequence analysis (sodA and plys genes) when required. The isolates were also identified with the MALDI Biotyper 3.1 (Bruker Daltonics, Bremen, Germany) using an updated library containing 6,903 Main Spectra Profiles (MSPs). All the analyzed S. pneumoniae were correctly identified with MALDI-TOF MS at species level using the most updated database and all the non-pneumococcal SMG isolates were also identified at the group level. Several peaks (4,964.32, 6,888.90, and 9,516.46 m/z) have been found to be specific of S. pneumoniae, whilst a different set of peaks have proved to be present only in S. mitis (6,839.07 m/z) and S. oralis (5,297.61, 5822.53, and 6,839.07 m/z). Peak analysis allowed correct species assignment of 101/101 S. pneumoniae isolates (100%) and 102/105 S. mitis/oralis isolates (97.1%). Thus, the implementation of MALDI-TOF MS plus peak analysis for the identification of this group of microorganisms may provide precise species-level information that will allow the early implementation of directed antibiotic therapy.
Mycobacteria identification by MALDI-TOF MS requires not only a good protein extraction protocol but also an adequate cut-off score in order to provide reliable results. The aim of this study was to assess the cut-off scores proposed by the MALDI-TOF MS system for mycobacteria identification. A total of 693 clinical isolates from liquid media and 760 from solid media were analysed, encompassing 67 different nontuberculous mycobacteria (NTM) species. MALDI-TOF MS identified 558 (80.5%) isolates from liquid media and 712 (93.7%) isolates from solid media with scores ≥1.60. Among these, four (0.7%) misidentifications were obtained from liquid media and four (0.5%) from solid media. Regarding species diversity, MALDI-TOF MS successfully identified 64 (95.5%) different species, while PCR-reverse hybridization (GenoType CM/AS) identified 24 (35.8%) different species. With a MALDI-TOF MS score ≥2 all isolates were correctly identified, as well as most isolates in the range 1.60-1.99, except M. angelicum, M. parascrofulaceum, M. peregrinum, M. porcinum and M. gastri. In conclusion, MALDI-TOF MS is a useful method for identifying a large diversity of NTM species. A score threshold of 1.60 proved useful for identifying almost all the isolates tested; only a few species required a higher score (≥2.00) to obtain a valid definitive identification.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.