Jamie S Scott1, Sarah A Sterling1, Harrison To1, Samantha R Seals2, Alan E Jones1. 1. a Department of Emergency Medicine , University of Mississippi Medical Center , Jackson , MS , USA ; 2. b Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center , Jackson , MS , USA.
Abstract
BACKGROUND: Matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) has shown promise in decreasing time to identification of causative organisms compared to traditional methods; however, the utility of MALDI-TOF MS in a heterogeneous clinical setting is uncertain. OBJECTIVES: To perform a systematic review on the operational performance of the Bruker MALDI-TOF MS system and evaluate published cut-off values compared to traditional blood cultures. METHODS: A comprehensive literature search was performed. Studies were included if they performed direct MALDI-TOF MS analysis of blood culture specimens in human patients with suspected bacterial infections using the Bruker Biotyper software. Sensitivities and specificities of the combined studies were estimated using a hierarchical random effects linear model (REML) incorporating cut-off scores of ≥1.7 and ≥2.0. RESULTS: Fifty publications were identified, with 11 studies included after final review. The estimated sensitivity utilising a cut-off of ≥2.0 from the combined studies was 74.6% (95% CI = 67.9-89.3%), with an estimated specificity of 88.0% (95% CI = 74.8-94.7%). When assessing a cut-off of ≥1.7, the combined sensitivity increases to 92.8% (95% CI = 87.4-96.0%), but the estimated specificity decreased to 81.2% (95% CI = 61.9-96.6%). CONCLUSIONS: In this analysis, MALDI-TOF MS showed acceptable sensitivity and specificity in bacterial speciation with the current recommended cut-off point compared to blood cultures; however, lowering the cut-off point from ≥2.0 to ≥1.7 would increase the sensitivity of the test without significant detrimental effect on the specificity, which could improve clinician confidence in their results.
BACKGROUND: Matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) has shown promise in decreasing time to identification of causative organisms compared to traditional methods; however, the utility of MALDI-TOF MS in a heterogeneous clinical setting is uncertain. OBJECTIVES: To perform a systematic review on the operational performance of the Bruker MALDI-TOF MS system and evaluate published cut-off values compared to traditional blood cultures. METHODS: A comprehensive literature search was performed. Studies were included if they performed direct MALDI-TOF MS analysis of blood culture specimens in humanpatients with suspected bacterial infections using the Bruker Biotyper software. Sensitivities and specificities of the combined studies were estimated using a hierarchical random effects linear model (REML) incorporating cut-off scores of ≥1.7 and ≥2.0. RESULTS: Fifty publications were identified, with 11 studies included after final review. The estimated sensitivity utilising a cut-off of ≥2.0 from the combined studies was 74.6% (95% CI = 67.9-89.3%), with an estimated specificity of 88.0% (95% CI = 74.8-94.7%). When assessing a cut-off of ≥1.7, the combined sensitivity increases to 92.8% (95% CI = 87.4-96.0%), but the estimated specificity decreased to 81.2% (95% CI = 61.9-96.6%). CONCLUSIONS: In this analysis, MALDI-TOF MS showed acceptable sensitivity and specificity in bacterial speciation with the current recommended cut-off point compared to blood cultures; however, lowering the cut-off point from ≥2.0 to ≥1.7 would increase the sensitivity of the test without significant detrimental effect on the specificity, which could improve clinician confidence in their results.
Authors: Behzad Nadjm; Vu Quoc Dat; James I Campbell; Vu Tien Viet Dung; Alessandro Torre; Nguyen Thi Cam Tu; Ninh Thi Thanh Van; Dao Tuyet Trinh; Nguyen Phu Huong Lan; Nguyen Vu Trung; Nguyen Thi Thuy Hang; Le Thi Hoi; Stephen Baker; Marcel Wolbers; Nguyen Van Vinh Chau; Nguyen Van Kinh; Guy E Thwaites; H Rogier van Doorn; Heiman F L Wertheim Journal: J Infect Date: 2019-03-23 Impact factor: 6.072
Authors: F J Candel; C M Rico; I Díaz de la Torre; B Laguna; J Martínez-Jordán; S Medrano; M C Escobar-Porcel; A López-Delgado; L López-González; J M Viñuela-Prieto; M Matesanz; J González Del Castillo; A Arribi Journal: Rev Esp Quimioter Date: 2019-09 Impact factor: 1.553
Authors: Ahmed S Keshta; Nazik Elamin; Mohammad Rubayet Hasan; Andrés Pérez-López; Diane Roscoe; Patrick Tang; Mohammed Suleiman Journal: Microbiol Spectr Date: 2021-12-08