b Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been found to be an accurate, rapid, and inexpensive method for the identification of bacteria and yeasts. Previous evaluations have compared the accuracy, time to identification, and costs of the MALDI-TOF MS method against standard identification systems or commercial panels. In this prospective study, we compared a protocol incorporating MALDI-TOF MS (MALDI protocol) with the current standard identification protocols (standard protocol) to determine the performance in actual practice using a specimen-based, bench-by-bench approach. The potential impact on time to identification (TTI) and costs had MALDI-TOF MS been the firstline identification method was quantitated. The MALDI protocol includes supplementary tests, notably for Streptococcus pneumoniae and Shigella, and indications for repeat MALDI-TOF MS attempts, often not measured in previous studies. A total of 952 isolates (824 bacterial isolates and 128 yeast isolates) recovered from 2,214 specimens were assessed using the MALDI protocol. Compared with standard protocols, the MALDI protocol provided identifications 1.45 days earlier on average (P < 0.001). In our laboratory, we anticipate that the incorporation of the MALDI protocol can reduce reagent and labor costs of identification by $102,424 or 56.9% within 12 months. The model included the fixed annual costs of the MALDI-TOF MS, such as the cost of protein standards and instrument maintenance, and the annual prevalence of organisms encountered in our laboratory. This comprehensive cost analysis model can be generalized to other moderate-to high-volume laboratories.

Aims: (i) Evaluation of delayed time to blood culture extraction by the Sepsityper kit and impact of shipping pellets off-site for MALDI-TOF MS analysis. (ii) Comparison of Sepsityper and laboratory-developed extraction methods from a literature review. Methods and Results: Using two blood culture systems (BD BACTEC and VersaTREK), we extracted 411 positive blood cultures using the Sepsityper kit to mimic a potential protocol for institutions without a MALDI-TOF MS. Extracted pellets were shipped and analysed on the Bruker UltraflexIII. Successful extraction of 358 (87Á1%) samples was determined by the presence of detectable proteins. MALDI-TOF MS correctly identified 332 (80Á8%) samples. Conclusions: Delayed time to extraction did not affect Sepsityper extraction or MALDI-TOF MS accuracy. The extracted pellets remain stable and provide accurate results by MALDI-TOF MS when shipped at room temperature to off-site reference laboratories. Significance and Impact of the Study: This is the first study to show that institutions without a MALDI-TOF MS can take advantage of this innovative technology by shipping a volume of blood to an off-site laboratory for extraction and MALDI-TOF MS analysis. We also performed a literature review to compare various extraction methods.

Mumps is an acute viral illness characterized by fever and parotitis that typically affects young children. 1 Clinical manifestations start with a non-specific prodrome, which can include malaise and headache, and are followed by painful swelling of the parotid glands. Less common presentations include epididymo-orchitis, oophoritis, pancreatitis and meningoencephalitis. Approximately half of those infected develop classical disease, the remainder having non-specific or respiratory symptoms and 15-20% being asymptomatic. 2,3 Most of those who are symptomatic recover fully. There is currently no specific antiviral treatment available, but mumps vaccine has been available since the 1960s. 4 The introduction of the scheduled mumps-measles-rubella (MMR) childhood vaccination in 1967 has resulted in a dramatic decrease of disease incidence in North America. 5 However, mumps has reemerged since 2004, with outbreaks reported in Europe, 6 US 7 and Canada. 8 These outbreaks have been documented in vaccinated populations, frequently affecting older children and young adults, suggesting that current vaccines are not adequately protective over the long term. 9 Control measures for mumps consist of immunization of susceptible populations and isolation of those symptomatic or potentially exposed. Post-exposure prophylaxis with vaccine or immunoglobulin is not known to prevent infection. 10 Recently, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics have recommended shortening the isolation period from 9 days to 5 days after the onset of parotitis. 11 This was based on limited historical studies performed prior to the availability of mumps vaccination, and one small 2008 study in a highly vaccinated population 12 in which virus detection, hence the potential for transmission, was observed to be highest prior to the onset of parotitis and within the subsequent 5 days. This recommendation was also based in part on improved compliance among university students isolated for shorter periods (4 days) compared to those isolated for up to 9 days. 13 The Canadian guidelines for the prevention and control of mumps have similarly adopted a 5-day case isolation period. 14 A mumps outbreak occurred in a highly unvaccinated population in British Columbia (BC), Canada, from February to October 2008. Most of the affected unimmunized population belonged to a small faith-based community who opted out of scheduled vaccination. The outbreak was managed by using provincial mumps control guidelines, including programs for enhanced surveillance and public awareness, in the specific geographic region of the epidemic. After the outbreak resolved, we retrospectively utilized clin-

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