Rapid and cost-effective matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS)-based systems will replace conventional phenotypic methods for routine identification of bacteria. We report here the first evaluation of the new MALDI-TOF MS-based Vitek MS system in a large clinical microbiology laboratory. This system uses an original spectrum classifier algorithm and a specific database designed for the identification of clinically relevant species. We have tested 767 routine clinical isolates representative of 50 genera and 124 species. Vitek MS-based identifications were performed by means of a single deposit on a MALDI disposable target without any prior extraction step and compared with reference identifications obtained mainly with the VITEK2 phenotypic system; if the identifications were discordant, molecular techniques provided reference identifications. The Vitek MS system provided 96.2% correct identifications to the species level (86.7%), to the genus level (8.2%), or within a range of species belonging to different genera (1.3%). Conversely, 1.3% of isolates were misidentified and 2.5% were unidentified, partly because the species was not included in the database; a second deposit provided a successful identification for 0.8% of isolates unidentified with the first deposit. The Vitek MS system is a simple, convenient, and accurate method for routine bacterial identification with a single deposit, considering the high bacterial diversity studied and as evidenced by the low prevalence of species without correct identification. In addition to a second deposit in uncommon cases, expanding the spectral database is expected to further enhance performances.
Due to the dramatic increase of bacterial resistance and to the ecological cost of broad-spectrum antimicrobial therapies, rapid and accurate identification (ID) of bacteria is essential for the appropriate management of infections. Conventional identification methods require at least 4 to 12 h, and molecular methods are not suitable for large-scale routine identification.Nearly 40 years ago, chemists proposed to identify bacterial cultures via the detection of small organic molecules using mass spectrometry (2). More than 10 years later, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) allowed the detection of intact larger biomolecules, such as proteins, and was further developed for microbial ID in routine clinical laboratories (13). During the analysis process, proteins are ionized without fragmentation by the coordinated action of the laser and the small organic acids of the matrix and separated on the basis of their mass-to-charge ratios, a process which results in a characteristic mass spectral profile. Microbial ID is based on the comparison of the protein spectrum generated from intact whole bacterial cells to a database of species-specific reference protein profiles using a particular algorithm.In the mid-1990s, different groups developed their own libraries of bacter...