Resistance against ␤-lactam antibiotics is a growing challenge for managing severe bacterial infections. The rapid and costefficient determination of ␤-lactam resistance is an important prerequisite for the choice of an adequate antibiotic therapy. ␤-Lactam resistance is based mainly on the expression/overexpression of ␤-lactamases, which destroy the central ␤-lactam ring of these drugs by hydrolysis. Hydrolysis corresponds to a mass shift of ؉18 Da, which can be easily detected by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Therefore, a MALDI-TOF MS-based assay was set up to investigate different enterobacteria for resistance against different ␤-lactam antibiotics: ampicillin, piperacillin, cefotaxime, ceftazidime, ertapenem, imipenem, and meropenem. ␤-Lactamases are enzymes that have a high turnover rate. Therefore, hydrolysis can be detected by MALDI-TOF MS already after a few hours of incubation of the bacteria to be tested with the given antibiotic. The comparison of the MS-derived data with the data from the routine procedure revealed identical classification of the bacteria according to sensitivity and resistance. The MALDI-TOF MS-based assay delivers the results on the same day. The approved routine procedures require at least an additional overnight incubation.

As the differential diagnosis of dementias based on established clinical criteria is often difficult, biomarkers for applicable diagnostic testing are currently under intensive investigation. Amyloid plaques deposited in the brain of patients suffering from Alzheimer's disease, dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) mainly consist of carboxy-terminally elongated forms of amyloid-beta (Aβ) peptides, such as Aβ1–42. Absolute Aβ1–42 levels in CSF have shown diagnostic value for the diagnosis of Alzheimer's disease, but the discrimination among Alzheimer's disease, DLB and PDD was poor. A recently established quantitative urea-based Aβ-sodium-dodecylsulphate–polyacrylamide-gel-electrophoresis with Western immunoblot (Aβ-SDS–PAGE/immunoblot) revealed a highly conserved Aβ peptide pattern of the carboxy-terminally truncated Aβ peptides 1–37, 1–38, 1–39 in addition to 1–40 and 1–42 in human CSF. We used the Aβ-SDS–PAGE/immunoblot to investigate the CSF of 23 patients with Alzheimer's disease, 21 with DLB, 21 with PDD and 23 non-demented disease controls (NDC) for disease-specific alterations of the Aβ peptide patterns in its absolute and relative quantities. The diagnostic groups were matched for age and severity of dementia. The present study is the first attempt to evaluate the meaning of Aβ peptide patterns in CSF for differential diagnosis of the three neurodegenerative diseases—Alzheimer's disease, DLB and PDD. The Aβ peptide patterns displayed disease-specific variations and the ratio of the differentially altered Aβ1–42 to the Aβ1–37 levels subsequently discriminated all diagnostic groups from each other at a highly significant level, except DLB from PDD. Additionally, a novel peptide with Aβ-like immunoreactivity was observed constantly in the CSF of all 88 investigated patients. The pronounced percentage increase of this peptide in DLB allowed a highly significant discrimination from PDD. Using a cut-off point of 0.954%, this marker yielded a diagnostic sensitivity and specificity of 81 and 71%, respectively. From several lines of indication, we consider this peptide to represent an oxidized α-helical form of Aβ1–40 (Aβ1–40*). The increased abundance of Aβ1–40* probably reflects a disease-specific alteration of the Aβ1–40 metabolism in DLB. We conclude that Aβ peptide patterns reflect disease-specific pathophysiological pathways of different dementia syndromes as distinct neurochemical phenotypes. Although Aβ peptide patterns failed to fulfil the requirements for a sole biomarker, their combined evaluation with other biomarkers is promising in neurochemical dementia diagnosis. It is noteworthy that DLB and PDD exhibit distinct clinical temporal courses, despite their similar neuropathological appearance. Their distinct molecular phenotypes support the view of different pathophysiological pathways for each of these neurodegenerative diseases.

Staphylococcus aureus causes a wide range of hospital infections. Often, these infections involve epidemic methicillin-resistant S. aureus (MRSA) strains that are transferred by health care workers to patients. In order to detect outbreaks that are caused by epidemic strains, the clinical isolates have to be typed. Multilocus sequence typing (MLST) relies on the sequence analysis of housekeeping genes and is used to allocate the strains to sequence types (ST), which can be grouped into clonal complexes (CC). This method has provided a detailed insight into the population structure of MRSA and methicillin-susceptible S. aureus (MSSA) strains (1). Finer discrimination is achieved by pulsed-field gel electrophoresis (PFGE) and spa typing (2). All of these methods need additional experimentation.In matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), different spectra or signatures of cell extracts (3, 4, 5, 6) or whole cells (7,8,9,10,11,12) could be identified for different strains or groups of strains. An increasing number of laboratories use MALDI-TOF MS for the identification of S. aureus. However, the differences in the signatures of the strains have not been evaluated so far, because the discriminatory threshold of the software used in clinical settings is set up to assign the isolate to a species. To this end, more subtle differences are ignored. Another reason is that, so far, MALDI-TOF MS of whole bacterial cells has been employed in a heuristic manner, and for most species, the identities of the compounds that are detected in the measurements are unknown. Thus, the spectra are not well understood, and the variations in the signatures cannot be interpreted.In principle, two spectra might differ by signal intensity, loss of a signal, or by the shift of a signal. Variations in signal intensity are probably caused by expression differences, which might be directly correlated with culture conditions and, therefore, do not give unambiguous information about a genotype of the strain. The loss of a signal is caused by the total failure to express a protein or peptide, which in turn might indicate a mutation causing a frameshift or stop codon, but might also depend on culture conditions, mutations of regulatory factors, or sample preparation. Thus, there is no clear-cut correlation between the loss of a signal and a genotype. In contrast, peak shifts (i.e., loss of a signal coupled to the appearance of a new signal, both of which are correlated to the same peptide) correspond to point mutations in the genes of the peptides detected in the analysis; the mutation leads to an amino acid exchange that alters the molecular weight of the corresponding gene product.In order to characterize the clonal lineages of S. aureus in the MALDI-TOF MS, this work was aimed at the identification of the peptides that are detected in the spectra and that show mass variations between the clonal complexes of S. aureus. To this end, we analyzed the spectra of 401 S. aureus strains, concentrating on...