T icks are obligate hematophagous arthropods that are the second most prevalent vectors of human zoonotic pathogens after mosquitoes (1). Ticks harbor a vast number of pathogenic bacteria, viruses, and protozoa (2). Emerging tickborne disease (TBD) agents that cause human infections, such as Borrelia miyamotoi and Rickettsia tamurae, have been reported (3). In Europe, ticks most frequently implicated in human infectious diseases are Ixodes, Rhipicephalus, and Dermacentor spp. (4). Tularemia, Crimean-Congo hemorrhagic fever, and tick-borne encephalitis are the 3 TBDs under specific surveillance by the European Centre for Disease Prevention and Control (5). Surveillance of other TBDs relies mainly on national reference centers, reports, literature analysis, and serologic surveys. Most TBDs have geographic disease patterns, and distribution evolves with climatic conditions and human behavioral modifications. Monitoring TBDs is critical for developing optimal prevention and management strategies (6).The Institut Hospitalo-Universitaire Méditerranée Infection (IHU-MI) in Marseille, France (7) includes the National Reference Centre for rickettsioses and bartonelloses and Southern Reference Center for tickborne diseases. The laboratory receives ticks collected from the field, animals, and patients in France and worldwide. Analyses include species-level tick identification and detection of tickborne human bacterial pathogens. Clinicians or patients are contacted to use this information for surveillance, medical advice, and treatment.In 2016, a study of tickborne bacteria and ticks removed from humans during 2002-2013 was conducted at the Aix-Marseille University (8). Innovative entomologic and microbiologic techniques were used for identification of ticks and bacteria, including molecular methods and matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. The principle of MALDI-TOF mass spectrometry identification resides in acquisition of species-specific mass spectra from a study sample. Spectra are secondarily queried against a reference mass spectral database, enabling identification on the basis of the spectra's similarity profile (9). This identification technique revolutionized everyday practices in clinical microbiology laboratories and has proven to be a robust, reproducible, and time-effective method for identifying arthropod vectors, notably ticks (9). We analyzed 418 ticks removed from humans and sent to the IHU-MI during 2014-2021, using MALDI-TOF mass spectrometry to identify the ticks and molecular methods and serology to identify tickborne pathogenic bacteria.